Graft‐versus‐host disease and herpes simplex virus oral injuries in onco‐hematological patient: Case report

• Published in: Special care in dentistry Vol. 42; no. 1; pp. 91 - 96
• Main Authors: Leidens, Natali, Ballardin, Bárbara Soldatelli, Leal, Gustavo André, Araújo, Arthur Magno Medeiros, Sessenta‐Junior, Claúdio Freire, Torres‐Pereira, Cassius Carvalho, Schussel, Juliana Lucena
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-01-2022
• Subjects: Adult; Antiviral agents; Antiviral Agents - therapeutic use; Biopsy; Case reports; Chronic infection; Chronic myeloid leukemia; Corticosteroids; Female; Graft vs Host Disease - drug therapy; Graft-versus-host reaction; Hematology; hematopoietic stem cell transplantation; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic stem cells; Herpes simplex; Herpes Simplex - drug therapy; Herpes viruses; Humans; Immunosuppression; Infections; leukemia myelogenous chronic; Myeloid leukemia; Patients; Photodynamic therapy; Simplexvirus; Stem cell transplantation; Steroids; Viral infections; hematopoietic stem cell transplantation; leukemia myelogenous chronic; herpes simplex
• ISSN: 0275-1879; 1754-4505
• DOI: 10.1111/scd.12640

Introduction
Graft‐versus‐host disease (GVHD) is a systemic complication that can affect patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) and the mouth is one of the places affected by the disease (oGVHD). Topical corticosteroids are used to control the painful symptoms, causing a local immunosuppression and increasing the risk for opportunistic infections.
Objective
This study aims to report a case of a 42‐year‐old woman, diagnosed with Chronic Myeloid Leukemia, who developed oGVHD and herpes simplex virus (HSV) infection after HSCT.
Case Report
oGVHD was confirmed by incisional biopsy and viral infection by HSV types 1 and 2 was confirmed by PCR. Topical and systemic corticotherapy and antiviral therapies were instituted. The immunosuppression intensified viral infection and antimicrobial photodynamic therapy (aPDT) was instituted as an adjuvant treatment. aPDT application, along with the patient's immune recovery, antivirals and corticosteroids resulted in clinical improvement of oral lesions.
Final Considerations
This study highlights aPDT as an effective adjunct therapy in the local treatment of opportunistic infections in onco‐hematological patients.