Periodontal disease as a manifestation of cyclic neutropenia: case report with a 34-year follow-up

Abstract

##Introduction Cyclic neutropenia is an autosomal-dominant haematological disorder. It is characterised by a periodic depression of peripheral blood neutrophils at 21-day intervals. Patients have a decreased ability to fight infection and commonly experience fever, ulceration, skin infections and lymphadenopathy. ##Case report A 17-year-old patient was referred by her consultant haematologist for periodontal assessment due to painful oral tissues and loose teeth. Clinical and radiographic examination revealed advanced periodontal destruction. A course of cause-related, non-surgical periodontal treatment, followed by an orthodontic and reconstructive phase, was carried out to arrest disease progression and stabilise her dentition. This case was followed up intermittently for over 34 years. ##Discussion The oral manifestations of cyclic neutropenia include oral ulcerations, angular cheilitis, periodontal destruction and early tooth loss. Early identification and regular follow-up should be employed for this patient cohort. Restorative procedures should be meticulously planned and executed to facilitate plaque control. ##Conclusion This case report illustrates the challenges of long-term management of severe periodontitis in a young individual who suffers from cyclic neutropenia. Delivery of dental and periodontal care was complicated by long travel distances, periods of non-attendance and financial issues. Early interventions to improve periodontal health and align the teeth proved successful, and this case report illustrates the benefit of planning periodontal care on a case-by-case basis. Regular supportive oral care is essential.