Chronic lymphocytic leukemia revealed by a rare complication: Noma. First description from Togo

Abstract

Introduction: Noma is defined as a gangrenous ulcerative stomatitis whose starting point is endobuccal. Its exact etiology remains unknown, but many risk factors have been described (malnutrition, poor hygiene, etc.). Chronic lymphoid leukemia (LLC) is a lymphoproliferative syndrome characterized by medullary proliferation of a B lymphocyte clone. It is not considered as a risk factor for noma disease. Observation: A 43-year-old patient is admitted in the odontostomatology unit of the Dapaong Regional Hospital Centre (Togo) for a deep lesion of the left cheek. The clinical examination allows to conclude the presence of a noma. Biological examinations also show a LLC at Binet stage C. In our patient, the LLC is associated with an immunosuppression and the development of infections due to the late diagnosis of the LLC. Comment: The immunosuppression and the development of infections are described in the literature as risk factors for noma disease. An association between LLC and noma could therefore exist. However, such association has been reported to date only once in the literature in 1976. Conclusion: Our observation suggests that the LLC could be a risk factor for noma disease. However, further studies based on large samples are necessary to conclude a causal association between LLC and noma.