2022 Volume 50 Issue 2 Pages 79-81
Immunoglobulin A (IgA) deficiency is an immunodeficiency disease with an approximate prevalence of 0.007% in Japan. Although most IgA-deficient individuals are asymptomatic, some develop recurrent infections, allergy, and autoimmune disease. IgA, which plays an important role in mucosal immunity, protects against infections of the mucous-secreting membrane lining the mouth, nasal sinus, respiratory tract, and digestive tract. Since dental procedures can cause bleeding and create openings where bacteria can enter the systemic circulation, perioperative infections are a key consideration in managing patients with IgA deficiency.
We report the case of a 5-year-old girl with IgA deficiency who underwent dental treatment including the extraction of 18 primary teeth under general anesthesia. She had undergone a detailed examination at the age of 4 years because of recurrent episodes of cellulitis, and she was diagnosed as having an IgA deficiency. During the currently reported dental treatment, anesthesia was induced with nitrous oxide, oxygen, and sevoflurane, then maintained with propofol and remifentanil. After 2 minutes of nasal packing with 0.5% povidone iodine along with 0.01% adrenaline solution, nasotracheal intubation was performed using a video laryngoscope. Prior to extubation, the oral cavity was washed with chlorhexidine. The following perioperative antibiotics were administered : 900 mg of amoxicillin (p.o.) 2 hours before surgery, 700 mg of ampicillin (i.v.) immediately before surgery, and 200 mg of amoxicillin (p.o.) three times a day for 4 days following surgery. The perioperative course was uneventful, and the patient was discharged one day after treatment. No symptoms of infection occurred during hospitalization or the post-discharge follow-up period.
Dental treatment and systemic perioperative management should be cautiously performed in IgA-deficient patients.
