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.
Tewari
Shikha
S
Department of Periodontics, Government Dental College, PT. B. D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, India. drshikhatewari@yahoo.com
Tewari
Sanjay
S
Sharma
Rajinder K
RK
Abrol
Pankaj
P
Sen
Rajeev
R
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