Article Text

AN UNUSUAL CASE OF HIGHLY INVASIVE INTRA-ORAL ASPERGILLOSIS INFECTION
  1. F Kemidi1,
  2. A Hutton1,
  3. V Clark1
  1. 1Dental and Maxillofacial Department, Birmingham Childrens Hospital NHS Foundation Trust, Birmingham, UK

Abstract

Objective We present a rare case of intra-oral aspergillosis infection in an immunocompromised two years old girl.

Methods A two years old caucasian girl with a medical history of severe aplastic anaemia was referred to the paediatric maxillofacial department regarding an intra-oral necrotic area. The 3 cm gingival lesion extended between the upper right primary central and lateral incisors up to the buccal sulcus and had quickly expanded over a few days. A saliva swab was positive for actinomycosis.

Results The patient underwent excisional biopsy of the intra-oral lesion. The specimen was submitted for histopathology results which showed invasive aspergillosis. Clinically the lesion appeared superficial and the maxillary bone appeared intact. CT scans of the maxillary sinuses also showed no bony lesions.

The patient had an uneventful recovery and she has been kept under intravenous broad spectrum antibiotics and antifungals (gentamycin, itraconazole and voriconazole) to date.

Discussion/clinical relevance Aspergillus is a world-wide fungus but it does not normally causes illness. In immunocompromised patients however, aspergillus fungi cause a spectrum of opportunistic infections especially in the lungs with non-specific symptoms including haemoptysis, pyrexia and malaise. The fungi can transfer to other organs, including the brain, the heart, the kidneys and the sinuses. Effective treatment consists of antifungal drug therapy. If aspergillosis resists the drug treatment, it is eventually fatal. A high mortality rate from aspergillosis is common in haematological malignancies. Our patient, despite two unsuccessful bone marrow transplants so far, responds successfully to the antifungal therapy and no episodes of recurrence have been reported.

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