Necrotizing stomatitis: a possible periodontal manifestation of deferiprone-induced agranulocytosis.
Thalassemia major is a rare inherited anemia, and affected children require blood transfusions every 2-4 weeks to survive. Repeated blood transfusions lead to a build-up of toxic levels of iron in the body, causing organ damage and premature death, primarily due to iron-induced heart disease. Deferiprone is one of a few drugs that are routinely used in medicine for the treatment of iron overload in thalassemic patients. This drug is usually administered daily at high doses (50-100 mg/kg) with a very low toxicity. Agranulocytosis is the most serious side effect of deferiprone, with a reported incidence of 0.6 per 100 patient-years. We document an illustrated case report of necrotizing gingivostomatitis, an oral manifestation of agranulocytosis secondary to deferiprone use involving the gingiva and palatal mucosa of a thalassemia major patient. Various causes of precipitation of agranulocytosis in these patients and a possible relationship of necrotizing gingivostomatitis with deferiprone are highlighted in this case report.
Department of Periodontics, Government Dental College, PT. B. D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, India. drshikhatewari@yahoo.com
Shikha
S
Tewari
Sanjay
S
Tewari
Rajinder K
RK
Sharma
Pankaj
P
Abrol
Rajeev
R
Sen
D000293:Adolescent; D000380:Agranulocytosis / Q000139:chemically induced* / Q000175:diagnosis; D000539:Alveolar Process / Q000473:pathology; D001803:Blood Transfusion; D000077543:Deferiprone; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D005881:Gingiva / Q000473:pathology; D005891:Gingivitis / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D007502:Iron Chelating Agents / Q000009:adverse effects*; D019190:Iron Overload / Q000188:drug therapy; D008297:Male; D009336:Necrosis; D009503:Neutropenia / Q000139:chemically induced; D011728:Pyridones / Q000009:adverse effects*; D013280:Stomatitis / Q000139:chemically induced* / Q000175:diagnosis; D017086:beta-Thalassemia / Q000628:therapy
D007502:Iron Chelating Agents; D011728:Pyridones; D000077543:Deferiprone