Favorable Outcome of Oral Pseudomonas Aeruginosa Infection With Bone Exposure During Hematopoietic Stem Cell Transplantation: a Case Report
Year: 2026
Type: article
Study design: Case Report
Abstract: Pseudomonas aeruginosa infection is a life-threatening complication in patients undergoing hematopoietic stem cell transplantation (HSCT) and is associated with a high mortality rate. Oral manifestations of this infection are uncommon and may present with distinctive clinical features. Herein, we report the case of a 35-year-old man with acute myeloid leukemia undergoing conditioning regimen with busulfan, fludarabine, and total marrow irradiation before HSCT, who received daily oral assessments and preventive photobiomodulation for oral mucositis by the Special Care Dentistry team. During the aplastic phase, a small petechial lesion on the mandibular interdental papilla rapidly progressed within 24-hours to painful violaceous and edematous lesions involving the gingiva and floor of the mouth. Based on the clinical findings, Pseudomonas aeruginosa infection was suspected. An oral swab was obtained for microbiological culture, and local management with antimicrobial photodynamic therapy and chlorhexidine mouthwash was initiated. Subsequently, cultures from the oral cavity, blood, central venous catheter, and anal region confirmed disseminated P. aeruginosa infection. Despite systemic antibiotic therapy with metronidazole, ceftolozane-tazobactam and amikacin, the patient developed pulmonary involvement requiring intensive care support and mechanical ventilation. Throughout hospitalization, the Special Care Dentistry team maintained daily bedside follow-up with photobiomodulation and antimicrobial photodynamic therapy as adjunctive treatment. Although extensive oral necrosis progressed to mandibular bone exposure, complete healing was achieved by day +106 after transplantation, without osteomyelitis or surgical intervention. This case highlights that careful oral surveillance may enable early recognition of disseminated bacterial infection in severely immunocompromised patients. Additionally, it emphasizes the importance of adjunctive oral therapies in controlling local complications and supporting favorable clinical outcomes during HSCT. This study received no specific financial support.
Institution: Hospital Israelita Albert Einstein
Language: English
Subfield: General Dentistry
Field: Dentistry
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223146181