Eko Rotary Nurtito1, Riani Setiadhi2

Oral Medicine Residency Program, Faculty of Dentistry, Padjadjaran University, Dr. Hasan Sadikin Hospital, Bandung, Indonesia

Department of Oral Medicine, Faculty of Dentistry, Padjadjaran University, Dr. Hasan

Sadikin Hospital, Bandung, Indonesia

Abstract

Objective: Necrotising ulcerative stomatitis (NUS) is a rare inflammatory disease with necrotizing ulceration of the oral mucosa. Characteristic of the lesion are acute ulcers  with massive damage, necrosis of soft tissue that can extend to the surrounding tissue. At the advanced stage, it can develop become cancrum oris (noma). HIV disturbs the balance between the host and coinfecting microbes, declining control of these potential pathogens, for example subclinical blasts of cytomegalovirus (CMV) replication at mucosal sites. Cytomegalovirus infection weakens periodontal defense and grants overgrowth of periodonto-pathogenic bacteria. This case report, about NUS related HIV/AIDS in the oral mucosa in which the necrotic ulceration lesions involving the gingiva and periodontium.

Case Report: A 33 years old male patient, was referred from the oral surgery department RSHS, complaining of a lump covered with a white layer. It began six months earlier with canker sores in the upper left gum that spread to the median palate. It was very painful and felt as if it was burning, especially when eating so that the patient could only eat baby biscuits and drink milk. Threemonths ago, the patient was diagnosed with HIV AIDS, and subsequently took ARV drugs regularly. CD4 count was 72 Cell/ µL and anti CMV IgG 46.3 U/mL.

Management: The patient was prescribed: amoxicillin 500mg, metronidazole 500mg, paracetamol 500mg, chlorhexidine gluconate 0.1% mouthwash and debridement of the necrotic tissue using 3% H2O2 liquid for five consecutive days. The lesion improved within two weeks.

Conclusion: HIV disrupts the balance between the host and coinfecting microbes, worsening control of these potential pathogens. For example, subclinical bursts of cytomegalovirus (CMV) replication at mucosal sites. Cytomegalovirus infection impairs periodontal defense and permits overgrowth of periodonto-pathogenic bacteria. Proper management, good communication and patient cooperation are needed to achieve optimal results in treating cases of Necrotizing Ulcerative Stomatitis in HIV patients.