Management of cancrum oris in a HIV-infected patient

Tatalaksana cancrum oris pada pasien terinfeksi HIV

Abstract

Cancrum oris, or noma, is a progressive orofacial gangrene with a high mortality rate that commonly occurs in individuals with severe immunosuppression, in-cluding those with human immunodeficiency virus (HIV) infection. This case report describes the management of noma in a 40-year-old woman with stage III HIV and a CD4 count of 18 cells/µL, who presented with a progressive necrotic lesion at the left commissure of the mouth, accompanied by septic shock, severe anaemia, electrolyte disturbances, and acute kidney injury. Clinical examination revealed a blackish necrotic lesion, oedema, haemorrhage and pus, consistent with the gangrenous phase of noma. Management was undertaken through a multidisciplinary approach, comprising haemodynamic stabilisation, correction of anaemia and electrolyte imbalances, broad-spectrum antibiotics, enteral nutritional support, local wound care, as well as debridement and primary closure. It was concluded that a rapid and integrated multidisciplinary approach is effective in improving the clinical condition and limiting the progress-ion of tissue destruction in HIV-associated noma.