A 3-year- old boy presented with fever for 20 days.
On day 5 of fever, he developed oral and angular mucosal ulcerations and
redness. Blood counts showed a granulocytopenia. There was rapid
progressive blackening of the labial and lingual surfaces of the gums
and loosening of teeth for last 3 days (Fig. 1 and 2).
We made a clinical diagnosis of acute necrotizing/gangrenous gingivitis.
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Fig. 1 Blackening of lingual surface of
gums extending to palate.
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Fig. 2 Blackening of lingual surface of
gums with loosening of teeth.
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Acute necrotizing gingivitis, an early lesion of noma,
begins as an inflammation of the marginal interdental papillae, to
subsequently involve the mucosal surfaces of cheek and lips. Clinical
features include a foul-smelling purulent oral discharge, halitosis,
salivation, cervical lymphadenopathy, and a grayish-black discoloration
of the oral mucosa. Progression to perforation of cheek is rapid if
untreated at this stage. Timely institution of local care in combination
with systemic antibiotics (penicillin with metronidazole) can avoid the
severe or fatal complications of noma.
Acknowledgments: Dr. S. Prabhu of BJ Wadia
Hospital for referring this case to us for diagnostic work up.
