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Yazdanpanah N, Rezaei N. The multidisciplinary approach to diagnosing inborn errors of immunity: a comprehensive review of discipline-based manifestations. Expert Rev Clin Immunol 2024:1-23. [PMID: 38907993 DOI: 10.1080/1744666x.2024.2372335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/21/2024] [Indexed: 06/24/2024]
Abstract
INTRODUCTION Congenital immunodeficiency is named primary immunodeficiency (PID), and more recently inborn errors of immunity (IEI). There are more than 485 conditions classified as IEI, with a wide spectrum of clinical and laboratory manifestations. AREAS COVERED Regardless of the developing knowledge of IEI, many physicians do not think of IEI when approaching the patient's complaint, which leads to delayed diagnosis, misdiagnosis, serious infectious and noninfectious complications, permanent end-organ damage, and even death. Due to the various manifestations of IEI and the wide spectrum of associated conditions, patients refer to specialists in different disciplines of medicine and undergo - mainly symptomatic - treatments, and because IEI are not included in physicians' differential diagnosis, the main disease remains undiagnosed. EXPERT OPINION A multidisciplinary approach may be a proper solution. Manifestations and the importance of a multidisciplinary approach in the diagnosis of main groups of IEI are discussed in this article.
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Affiliation(s)
- Niloufar Yazdanpanah
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Tan JY, Teo GN, Ng E, Tay ABG, Tay JRH. Gingival Necrosis Related to Sepsis-Induced Agranulocytosis Due to Pseudomonas aeruginosa Bacteraemia: A Case Report. J Clin Med 2024; 13:1285. [PMID: 38592105 PMCID: PMC10931707 DOI: 10.3390/jcm13051285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 04/10/2024] Open
Abstract
Background: There have been no reports of sepsis-induced agranulocytosis causing gingival necrosis in otherwise medically healthy patients to the authors' best knowledge. Even though there are several case reports of gingival necrosis secondary to medication-induced agranulocytosis, they have not systematically described the natural progression of agranulocytosis-related gingival necrosis. Methods: This paper presents a case report of a 29-year-old female Indian patient with generalised gingival necrosis and constitutive signs of intermittent fever, nausea, and vomiting. She also complained of abdominal pains. Blood counts showed agranulocytosis, and the patient was admitted for a workup of the underlying cause. Parenteral broad-spectrum antibiotics were administered, which brought about clinical resolution. Results: Her gingival necrosis was attributed to sepsis-induced agranulocytosis triggered by Pseudomonas aeruginosa bacteraemia, and upon clinical recovery, spontaneous exfoliation left behind exposed bone. Secondary healing over the exposed alveolar bone was noted after a year-long follow-up, albeit with some residual gingival recession. Conclusions: Oral manifestations of gingival necrosis, when present with concomitant constitutive symptoms, could indicate a serious underlying systemic condition that could be potentially life-threatening if left untreated. Dentists should be cognizant of this possibility so that timely intervention is not delayed.
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Affiliation(s)
| | - Guo Nian Teo
- Department of Oral and Maxillofacial Surgery, National Dental Centre, Singapore 168938, Singapore; (G.N.T.); (A.B.G.T.)
| | - Ethan Ng
- Department of Restorative Dentistry, National Dental Centre, Singapore 168938, Singapore;
| | - Andrew Ban Guan Tay
- Department of Oral and Maxillofacial Surgery, National Dental Centre, Singapore 168938, Singapore; (G.N.T.); (A.B.G.T.)
| | - John Rong Hao Tay
- Department of Restorative Dentistry, National Dental Centre, Singapore 168938, Singapore;
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Gomes RFT, Klein M, Castelo EF, Carrard VC. Generalized gingival necrosis in a patient under methimazole use. SPECIAL CARE IN DENTISTRY 2022. [PMID: 35981968 DOI: 10.1111/scd.12771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/17/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022]
Abstract
Hyperthyroidism is a common disease, with a prevalence between 0.2% and 0.5%, characterized by an increase in the synthesis and release of thyroid hormones. Management of this condition requires medical intervention to correct the hormonal imbalance and control its clinical manifestations. Methimazole is a thionamide derivative considered among the first-choice treatment options for hyperthyroidism. However, it may cause serious side effects such as neutropenia or agranulocytosis, which, although rare, can lead to death. The clinical manifestations of this complication range from fever, ulcerations in the oral and pharyngeal mucosa, tonsillitis, and lymphadenopathy to hemorrhagic necrosis and septicemia. This report describes the case of a patient with generalized gingival necrosis that was related to the use of methimazole for the treatment of hyperthyroidism.
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Affiliation(s)
- Rita Fabiane Teixeira Gomes
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Mariana Klein
- Outpatient Clinic of Stomatology Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil Egress
| | - Edilson Fernando Castelo
- Multi-professional Residency in Health, University of Santa Cruz do Sul, Santa Cruz do Sul, RS, Brazil
| | - Vinícius Coelho Carrard
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.,Oral Medicine Unit, Otorhinolaryngology Service, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazi
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Herrera D, Retamal-Valdes B, Alonso B, Feres M. Acute periodontal lesions (periodontal abscesses and necrotizing periodontal diseases) and endo-periodontal lesions. J Periodontol 2018; 89 Suppl 1:S85-S102. [DOI: 10.1002/jper.16-0642] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 06/29/2017] [Accepted: 07/30/2017] [Indexed: 12/16/2022]
Affiliation(s)
- David Herrera
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
| | - Belén Retamal-Valdes
- Department of Periodontology; Dental Research Division; Guarulhos University; Guarulhos São Paulo Brazil
| | - Bettina Alonso
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
| | - Magda Feres
- Department of Periodontology; Dental Research Division; Guarulhos University; Guarulhos São Paulo Brazil
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Herrera D, Retamal-Valdes B, Alonso B, Feres M. Acute periodontal lesions (periodontal abscesses and necrotizing periodontal diseases) and endo-periodontal lesions. J Clin Periodontol 2018; 45 Suppl 20:S78-S94. [DOI: 10.1111/jcpe.12941] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 06/29/2017] [Accepted: 07/30/2017] [Indexed: 01/29/2023]
Affiliation(s)
- David Herrera
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
| | - Belén Retamal-Valdes
- Department of Periodontology; Dental Research Division; Guarulhos University; Guarulhos São Paulo Brazil
| | - Bettina Alonso
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
| | - Magda Feres
- Department of Periodontology; Dental Research Division; Guarulhos University; Guarulhos São Paulo Brazil
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Souza LCD, Lopes FF, Bastos EG, Alves CMC. Oral infection by Pseudomonas aeruginosa in patient with chronic kidney disease - a case report. ACTA ACUST UNITED AC 2018; 40:82-85. [PMID: 29796582 PMCID: PMC6533965 DOI: 10.1590/1678-4685-jbn-3812] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 11/06/2017] [Indexed: 11/22/2022]
Abstract
Chronic renal patients are more susceptible to hospital complications and
infections such as urinary tract infections, peritonitis, surgery infections,
and bacteremia, which are often caused by Pseudomonas
aeruginosa. A case of a HIV-positive girl with chronic kidney
disease and with serious oral lesions due to P. aeruginosa
septic shock is presented. The patient showed necrotic lesions in the oral
mucosa, pathological tooth mobility, bone loss, and hematogenous osteomyelitis
in the maxilla. The patient was submitted to systemic antibiotic therapy based
on screening culture and treatment of bone lesions by eliminating the causal
agent and restoring health conditions. This case report is extremely important
for health professionals, since the oral cavity can be affected by this pathogen
or serve as a colonization site.
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Jandial A, Mishra K, Panda A, Lad D, Prakash G, Khadwal A, Varma N, Varma S, Malhotra P. Necrotising Ulcerative Gingivitis: A Rare Manifestation of Pseudomonas Infection. Indian J Hematol Blood Transfus 2018; 34:578-580. [PMID: 30127583 DOI: 10.1007/s12288-018-0927-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 01/29/2018] [Indexed: 10/18/2022] Open
Affiliation(s)
- Aditya Jandial
- 1Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kundan Mishra
- 1Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Asharam Panda
- 1Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepesh Lad
- 1Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Prakash
- 1Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alka Khadwal
- 1Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Varma
- 2Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash Varma
- 1Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- 1Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Kamasaki Y, Satoh K, Nishiguchi M, Hoshino T, Fujiwara T. Acute oral complications in a pediatric patient with acute lymphoid leukemia. Pediatr Int 2016; 58:484-487. [PMID: 26711327 DOI: 10.1111/ped.12829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 08/31/2015] [Accepted: 09/09/2015] [Indexed: 12/01/2022]
Abstract
Pseudomonas aeruginosa is a low-virulence pathogen that can cause infection in immunocompromised patients. Among pediatric hematologists, it is known that careful attention should be paid to P. aeruginosa as the bacteria responsible for intraoral inflammation, and antibiotic therapy targeting P. aeruginosa is the first-line treatment during neutropenia in patients with hematological malignancy. Immunosuppressed patients, however, are at high risk of developing inflammation. Here, we report a case involving a 10-year-old patient with acute lymphoid leukemia (ALL), in which P. aeruginosa synergistically acted with pre-existing gingivitis to induce unusual oral necrotic lesions, leading to acute buccal cellulitis and pus discharge from external sinus tracts.
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Affiliation(s)
- Yoko Kamasaki
- Department of Pediatric Dentistry, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kyoko Satoh
- Department of Pediatric Dentistry, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Miyuki Nishiguchi
- Department of Pediatric Dentistry, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomonori Hoshino
- Department of Pediatric Dentistry, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Taku Fujiwara
- Department of Pediatric Dentistry, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Szczawinska-Poplonyk A, Gerreth K, Breborowicz A, Borysewicz-Lewicka M. Oral manifestations of primary immune deficiencies in children. ACTA ACUST UNITED AC 2009; 108:e9-20. [PMID: 19596208 DOI: 10.1016/j.tripleo.2009.03.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Revised: 03/06/2009] [Accepted: 03/12/2009] [Indexed: 01/07/2023]
Abstract
An important task for both dentists and pediatricians dealing with patients manifesting different oral lesions is to be able to differentiate changes signaling systemic disease from those appearing without any concomitant serious health problem. In this article, symptomatology of selected primary immune deficiency diseases are discussed with particular emphasis on oral manifestations reported in this group of disorders. Facial, dental, and oral findings compose a constellation of symptoms observed in immunodeficiency diseases. Predisposition to bacterial invasion, cytokine dysregulation, tissue inflammatory process, and necrosis lead to early-onset oral lesions and periodontitis. Developmental abnormalities, periodontal disease, and oral lesions may accompany immunodeficiency and require particular awareness directed toward diagnosis of an underlying disease of the immune system.
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Affiliation(s)
- Aleksandra Szczawinska-Poplonyk
- Department of Pediatric Pneumonology, Allergology and Clinical Immunology, Karol Marcinkowski University of Medical Sciences, Poznan, Poland.
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Miyairi I, Franklin JA, Andreansky M, Knapp KM, Hayden RT. Acute necrotizing ulcerative gingivitis and bacteremia caused by Stenotrophomonas maltophilia in an immunocompromised host. Pediatr Infect Dis J 2005; 24:181-3. [PMID: 15702051 DOI: 10.1097/01.inf.0000151038.82538.de] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An 8-year-old girl with leukemia developed acute necrotizing ulcerative gingivitis with Stenotrophomonas maltophilia and herpes simplex virus. Progression to bacteremia with pathologic evidence of osteomyelitis occurred despite appropriate antimicrobial therapy. This case highlights the importance of prompt recognition, debridement and appropriate therapy in immunocompromised patients with acute necrotizing ulcerative gingivitis.
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Affiliation(s)
- Isao Miyairi
- Department of Infectious Diseases, St. Jude Children's Research Hospital, University of Tennessee Health Science Center, Memphis, TN 38105, USA.
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