Jawad Akhter Gilani, Asghar H Asghar, Ayub Khan.
Cancrum Oris in a patient with Leukemia.
J Coll Physicians Surg Pak Jan ;12(7):448-9.

Cancrum oris usually occurs due to the malnutrition and poor hygienic conditions. Fusobacterium necrophorum is considered to be the main causative organism. Early recognition of the process is imperative for effective treatment. In this way, it will prevent further destruction of the tissues. On the other hand, if destructive process continues, it may erode facial paperacious bone that may lead to marked disfigurement. We present a case report of five years old boy, who was a diagnosed case of acute lymphoblastic leukemia (ALL) and developed cancrum oris (CO) during induction treatment i.e., UK-11 protocol.

Case Report: A 5 years old young boy was admitted with epistaxis. On the basis of his bone marrow examination diagnosis of ALL was made. After nasal packing, patient was referred to Oncologist for chemotherapy. He was given vincristine, prednisolone, and L-asparaginase. He was also transfused fresh blood and platelets. In spite of nasal packing, epistaxis restarted after 12 days, the nasal packing was replaced and bleeding stopped. On the next day he developed blackening of left ala nose with high-grade fever of 103oF. The blackening started increasing in size and encompassed whole of the nose. It also involved the medial canthus of left eye and the hard palate (Figure 1). There was foul smell from the local area. Patient had started mouth breathing. His total serum protein and albumin-globulin ratio was normal. Culture sensitivity was not performed. His total leukocyte count (TLC) was 900/mm.3 Cefipime was started in conjunction with amikacin and his induction therapy continued. In two months period the blackened tissue started delineating from normal healthy tissue and a rim of healthy tissue involving upper lip separated out without bleeding. The oral intake of the patient was poor so parenteral support was started for the time being, with amino acids and fatty acids. The patient showed little improvement but attendants took him home denying further treatment. Patient recovered after three weeks and the necrosed tissue sloughed out. He came back with amputated nose, loss of left eye lid and sight. There was also an elongated hole in hard palate making a direct communication of oral cavity to exterior. At home, he did not take any specific medicine for ALL except oral solid and liquid diet. He was regularly coming to hospital and had completed consolidation as well as cranial prophylaxis. He was scheduled to be seen by a plastic surgeon with regard to his residual defect.

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