title: Oral manifestations during chemotherapy for acute lymphoblastic leukemia: a case report.
abstract: A 14-year-old, male patient was referred for the treatment of mucositis, idiopathic facial asymmetry, and candidiasis. The patient had been undergoing chemotherapy for 5 years for acute lymphoblastic leukemia. He presented with a swollen face, fever, and generalized symptomatology in the mouth with burning. On physical examination, general signs of poor health, paleness, malnutrition, and jaundice were observed. The extraoral clinical examination showed edema on the right side of the face and cutaneous erythema. On intraoral clinical examination, generalized ulcers with extensive necrosis on the hard palate mucosa were observed, extending to the posterior region. Both free and attached gingivae were ulcerated and edematous with exudation and spontaneous bleeding, mainly in the superior and inferior anterior teeth region. The tongue had no papillae and was coated, due to poor oral hygiene. The patient also presented with carious white lesions and enamel hypoplasia, mouth opening limitation, and foul odor. After exfoliative cytology of the affected areas, the diagnosis was mixed infection by Candida albicans and bacteria. Recommended treatment was antibiotics and antifungal administration, periodontal prophylaxis, topical application of fluor 1.23%, and orientation on and control of proper oral hygiene and diet during the remission phase of the disease.
authors.affiliation: Department of Biosciences and Oral Diagnosis, São José dos Campos Dental School, São Paulo State University, UNESP, São Paulo, Brazil. mfgomes@fosjc.unesp.br
authors.forename: Mônica Fernandes
authors.initials: MF
authors.lastname: Gomes
authors.forename: Katya Rodrigues
authors.initials: KR
authors.lastname: Kohlemann
authors.forename: Glauco
authors.initials: G
authors.lastname: Plens
authors.forename: Marcelo Milone
authors.initials: MM
authors.lastname: Silva
authors.forename: Elitânia Marinho
authors.initials: EM
authors.lastname: Pontes
authors.forename: João Carlos
authors.initials: JC
authors.lastname: da Rocha
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002180:Candidiasis, Oral / Q000188:drug therapy / Q000382:microbiology*; D005146:Facial Asymmetry / Q000150:complications; D005892:Gingivitis, Necrotizing Ulcerative / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents