2017 Volume 38 Issue 2 Pages 179-185
In order to prevent chemotherapy-induced febrile neutropenia, radical and complete dental treatment is highly recommended before initiating cancer chemotherapy. Here, we present the case of a 4-year-old girl with severe dental caries who was treated on the second day of initiating cancer chemotherapy. She was diagnosed with acute myeloid leukemia on her first visit to the Department of Pediatric Oncology in our hospital. The next day, initial cytotoxic chemotherapy was initiated, and the patient was referred to our department for evaluation of oral infectious disease. We found severe dental caries and pulpitis on an intraoral examination. Because the patient was at high risk of tumor lysis syndrome, rasburicase was used to prevent acute kidney injury；no clinical manifestations were observed. We chose urgent treatment before the onset of myelosuppression from chemotherapy, and on the following day, comprehensive dental treatment was performed under general anesthesia. After tracheal extubation, she developed acute respiratory distress syndrome as a clinical manifestation of tumor lysis syndrome. Chemotherapy was discontinued for 20 days to allow the improvement of respiratory function. After her recovery from acute respiratory distress syndrome, chemotherapy was reinitiated and the patient showed complete remission without experiencing any critical oncologic emergencies. Dental procedures should be minimally invasive after initiating chemotherapy to prevent life-threatening complications associated with chemotherapy.
