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. Deferi...

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Published in:Oral surgery, oral medicine, oral pathology, oral radiology and endodontics oral medicine, oral pathology, oral radiology and endodontics, 2009-10, Vol.108 (4), p.e13-e19
Main Authors: Tewari, Shikha, BDS, MDS, Tewari, Sanjay, BDS, MDS, Sharma, Rajinder K., BDS, MDS, Abrol, Pankaj, MD, Sen, Rajeev, MD
Format: Article
Language:English
Subjects:
Adolescent
Agranulocytosis - chemically induced
Agranulocytosis - diagnosis
Alveolar Process - pathology
beta-Thalassemia - therapy
Blood Transfusion
Diagnosis, Differential
Follow-Up Studies
Gingiva - pathology
Gingivitis - chemically induced
Gingivitis - diagnosis
Humans
Iron Chelating Agents - adverse effects
Iron Overload - drug therapy
Male
Necrosis
Neutropenia - chemically induced
Pyridones - adverse effects
Stomatitis - chemically induced
Stomatitis - diagnosis
Surgery
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Summary: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.
ISSN:1079-2104
1528-395X
DOI:10.1016/j.tripleo.2009.06.021