A Rare Case Report about Noma or Cancrum Oris Occurring in a Neutropenic Patient

Objectives: To discuss the etiology, diagnosis, and management of Noma, a rare and devastating disease of the facial tissues

Methods: Case report

Results: The authors describe a case of Noma in a 50-year-old female who developed a gangrenous oro-facial lesion of her left face after cytotoxic chemotherapy for acute lymphoblastic leukemia. The patient was treated with broadspectrum intraveous antibiotics and extensive debridement of necrotic tissues followed by reconstruction of the large fullthickness defect.

Conclusion: Noma, or cancrum oris, is an uncommon ailment not well known in Europe or North America. Without treatment, the mortality rate of this dehumanizing infectious disease is 70%−90%. Early intervention and prevention of noma lesions in immunocompromised adults by optimizing their nutritional status, encouraging oral hygiene, maintaining adequate hydration, and closely monitoring intraoral lesions seems to be the key. Early lesions, such as acute necrotizing ulcerative gingivitis (ANUG), should be treated aggressively with oral hygiene, antibiotics (intravenous penicillin), and conservative debridement of necrotic tissues in addition to addressing the patient's hydration and nutritional status. If uncontrolled, Noma can destroy large amounts of both hard and soft tissues of the face which can present a formidable reconstructive challenge.