See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/334785517 Oral Presentation of Chronic Hyperplastic Candidiasis in Patient under Imatinib Mesylate: A Rare Case Article · April 2016 DOI: 10.17354/cr/2016/217 CITATIONS READS 0 50 4 authors , including: Zameera KN Naik KLE VK Institute of Dental Sciences 21 PUBLICATIONS 54 CITATIONS SEE PROFILE Some of the authors of this publication are also working on these related projects: educational research View project premalignant conditions View project All content following this page was uploaded by Zameera KN Naik on 31 July 2019. The user has requested enhancement of the downloaded file.
Case Report DOI: 10.17354/cr/2016/217 Oral Presentation of Chronic Hyperplastic Candidiasis in Patient under Imatinib Mesylate: A Rare Case Vishwanath Pattar 1 , Zameera Nalaband 2 , Anjana Bagewadi 3 1 Post Graduate Student, Department of Oral Medicine and Radiology, KLE Vishwanath Katti Institute of Dental Sciences, Belagavi, Karnataka, India, 2 Professor, Department of Oral Medicine and Radiology, KLE Vishwanath Katti Institute of Dental Sciences, Belagavi, Karnataka, India, 3 Head and Professor, Department of Oral Medicine and Radiology, KLE Vishwanath Katti Institute of Dental Sciences, Belagavi, Karnataka, India Candida albicans is the major human pathogen among Candida species. It is a commensal yeast of the oral, gastrointestinal, and vaginal mucosa in healthy individuals. Tie genus Candida has about 154 species, and difgerent species show a difgerent level of resistance to antifungal drugs and have a high degree of phenotypic similarity. Oropharyngeal candidiasis is the most common infection in oral cavity both pre- and post-treatment of cancer. Immunocompromised state in a cancer patient induces candidal species which get activated as a pathogen. It is found that in certain high-risk groups antifungal prophylaxis reduces the incidence and severity of infections. Tiis case report discusses the occurrence of hyperplastic candidiasis in the patient under treatment by a chemotherapeutic agent imatinib mesylate for gastric tumor. We have discussed the probable cause for oral candidiasis in patients under imatinib mesylate and treatment advised for the oral hyperplastic candidiasis. Keywords: Candida , Candidiasis, Chemotherapy, Imatinib mesylate INTRODUCTION Some cases have been reported about the lesion in the oral cavity such as painful erosions with lichenoid reactions in patients under imatinib mesylate. 5 Till date, there are no Imatinib mesylate is a chemotherapeutic drug, which case reports about occurrence of oral candidiasis in patients acts as a tyrosine kinase inhibitor and is used in the who are under treatment of imatinib mesylate. The most treatment of acute lymphoblastic leukemia, chronic common form of oral candidiasis in cancer patients are eosinophilic leukemia, gastrointestinal stromal tumor, pseudomembranous and erythematous type of candidiasis myelodysplastic/myeloproliferative neoplasm, systemic while the hyperplastic type of candidiasis is rarely reported. 6 mastocytosis, etc. 1,2 Short-term toxicity of the imatinib Herein, we report a rare case of oral hyperplastic candidiasis mesylate in 1-10% includes pancytopenia, febrile in a patient under the treatment of malignant gastric tumor neutropenia, and fmushing. Imatinib mesylate inhibition of with imatinib mesylate. c-kit and platelet-derived growth factor receptors (PDGF-R), which plays role in normal immune responses, causing CASE REPORT altered immune function. 2 It has been reported that there is a signifjcant hypogammaglobulinemia in patients treated A 48-year-old female patient reported to our Department of with imatinib mesylate. 3 Fungal infections in patients Oral Medicine and Radiology with a chief complaint of pain under certain other chemotherapeutic drugs occurs due in the gums in both right and left side of lower jaw. The pain to suppressed oral/mucosal immunity, salivary gland was moderate, burning type, intermituent, and aggravates dysfunction causing xerostomia and alteration in oral fmora. 4 while chewing food or drinking water relieves on taking Access this article online rest. The patient gave medical history of malignant tumor in the hypogastric region on left side for which she had : 02-2016 undergone surgery 4 months back. The patient was on the Month of Submission : 03-2016 Month of Peer Review medication, glivac 400 mg tablets (imatinib mesylate 400 mg, : 03-2016 Month of Acceptance Novartis Pharma AG, Swit{erland) daily since 4 months. On : 04-2016 Month of Publishing general examination subconjunctival pallorness, pallorness www.ijsscr.com of the nail bed were seen. On extra oral examination, Corresponding Author: Dr. Vishwanath Pattar, Department of Oral Medicine and Radiology, KLE Vishwanath Katti Institute of Dental Sciences, Nehru Nagar, Belagavi - 590 010, Karnataka, India. E-mail: dr.vishwanthpattar@gmail.com 17 IJSS Case Reports & Reviews | April 2016 | Vol 2 | Issue 11
Pattar, et al .: A Rare Case of Oral Presentation of Chronic Hyperplastic Candidiasis in Patient under Imatinib Mesylate submandibular lymph nodes were palpable on both right advised wherein Candida albicans were isolated. On the and left side 3 in number on the right side and 1 in number basis of history, clinical and pathological fjndings, a fjnal on the left side. Lymph nodes were of dimension 1 cm each diagnosis of chronic hyperplastic candidiasis was given. in left side and 1.5 cm on right side. Lymph nodes were fjrm Antifungal treatment with clotrimazole 1% mouth paint in consistency, tender on palpation, mobile. On intraoral and chlorhexidine mouthwash of 0.12% were started and examination white hyperkeratotic patch was seen on gingiva followed up after 2 weeks, and there was 30% decrease in extending from distal of 43 to mesial of 47 and anteriorly in the size of the lesion (Fig ures 3 and 4). Further follow-up of relation to 32, 31, 41, 42 and on left side in relation to 34, 35 patient was not possible in the event of death of the patient. and lingual to 47, 48 of the mandibular jaw (Fig ures 1 and 2). DISCUSSION Superiorly hyperkeratotic patch extending from atuached gingival to the buccal vestibular region inferoirly. Surface Mutations of c-kit proto-oncogene are reported in 85%, over the hyperkeratotic area was rough and borders were irregular. Gingiva surrounding the hyperkeratotic area was and mutations of PDGF-Rα chain are reported in 35% of erythematous and tender on palpation. Hyperkeratotic area gastointestinal tumors. 7 BCR-ABL tyrosine kinase is the product of Philadelphia chromosome, which is a causative was non-scrapable on application of pressure with gauze piece at its entire extent. There was the presence of white factor for chronic myelogenous leukemia. 8 Imatinib is coating on the tongue. an inhibitor of the receptor tyrosine kinases for PDGF and stem cell factor (SCF), c-kit, and inhibits PDGF and Superfjcial layer was forcibly scraped ofg with blunt end SCF-mediated cellular events and thereby acts as anti-tumor of the BP blade, and the pathological evaluation was drug. 2 Therefore, imatinib mesylate is used either as the Figure 1: Pre-treatment image showing hyperkeratotic area on the buccal Figure 3: Post-treatment image with reduced hyperkeratotic area on buccal aspect of 43-47 aspect of 43-47 Figure 2: Pre-treatment image showing hyperkeratotic area on the labial aspect Figure 4: Post-treatment image with reduced hyperkeratotic area on labial of 43 on right side to 35 on left side aspect 43-35 region 18 IJSS Case Reports & Reviews | April 2016 | Vol 2 | Issue 11
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