title: Severe presentation of necrotizing ulcerative periodontitis in a Nigerian HIV-positive patient: a case report.
abstract: OBJECTIVE
  To report a case of severe necrotizing ulcerative periodontitis (NUP) with a rarely associated sequestrum formation in a Nigerian HIV-positive patient.
  
  
  METHODS
  A 47-year-old HIV-positive male patient with no history of previous dental visits presented with a severe toothache in his lower jaw of 4 weeks' duration, which had affected his ability to chew properly. Clinical examination revealed marked gingival inflammation, moderate gingival recession and mobility of some of his lower anterior teeth: 31, 32, and 33. There was also a sequestrum present associated with the affected teeth. His CD4 cell count was 226 cells/mm(3). His viral load was very high (360,082 copies/ml). The intervention included thorough debridement of the necrotic lesion and sequestrectomy. The patient responded well to treatment after 1 week of follow-up. Unfortunately, the CD4 count was not assessed further because the patient was lost to follow-up.
  
  
  CONCLUSIONS
  This case showed that a high CD4 cell count does not necessarily prevent the occurrence of NUP in HIV-positive patients. Intervention might have enhanced a rapid positive response to the treatment within a short time.
authors.affiliation: Department of Preventive Dentistry, Faculty of Dental Sciences, College of Medicine, University of Lagos, Lagos, Nigeria. kumeiz09@gmail.com
authors.forename: Kehinde Adesola
authors.initials: KA
authors.lastname: Umeizudike
authors.forename: Kofoworola Olaide
authors.initials: KO
authors.lastname: Savage
authors.forename: Patricia Omowunmi
authors.initials: PO
authors.lastname: Ayanbadejo
authors.forename: Sulaimon Akanni
authors.initials: SA
authors.lastname: Akanmu
mesh_terms: D010520:Aggressive Periodontitis / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery / Q000821:virology; D018791:CD4 Lymphocyte Count; D003646:Debridement; D005892:Gingivitis, Necrotizing Ulcerative / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery / Q000821:virology; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D019562:Viral Load