Page 108 - FINAL COMPENDIUM 2020-2021 27.2.2022

POST EXTRACTION COMPLICATIONS IN A CHILD WITH AUTOIMMUNE
LYMPHOPROLIFERATIVE SYNDROME: A CASE REPORT

Noorliyana M, Ng MY, Suhaila M
Introduction: Autoimmune Lymphoproliferative Syndrome (ALPS) is a chronic non-
malignant, non-infectious rare genetic disorder, with uncontrolled proliferation of
lymphocytes commonly accompanied by autoimmune manifestations. Case report: A 5-
year-old girl with underlying ALPS was referred for the management of facial cellulitis
secondary to a non-vital mandibular right primary molar. She also has multiple dental
caries on the rest of her primary dentition. Having completed a course of antibiotics, the
cellulitis resolved and the causative tooth was planned for extraction under local
anaesthesia, after thorough discussion with her visiting paediatric oncologist. The
procedure was carried out with an acceptable preoperative platelet level, pre- and post-
procedure oral tranexamic acid, and local measures were used to manage the bleeding
right after extraction. The patient was discharged home uneventfully on the day of
extraction, only to return five days later with ooze from the extraction site, and a blood
clot of increasing size. She was admitted for further blood workup and intravenous
antibiotics. With an acceptable prothrombin time and activated partial thromboplastin
time, but low platelet level, platelet transfusion was performed by the paediatric medical
team, followed by wound toileting and suturing of the extraction site. Over the 11 days
length of her hospital admission, four episodes of platelet transfusion were carried out
due to recurrence of bleeding and low platelet levels. She was finally discharged after the
fourth transfusion which was done concurrently with wound toileting and suturing using
a non-absorbable suture and horizontal mattress suturing technique at the extraction site.
At her review appointment, the extraction site was healing well without any signs of
infection. Conclusion: An multidisciplinary team is needed to manage patients with
autoimmune disease and dental care should not be neglected from the very beginning.
This patient is fortunate that the other dentitions are restorable and future extraction can
be avoided to prevent an episode of bleeding.

Virtual poster presentation at the 22 NIH Scientific Conference (Virtual Conference) 2021 on 21 – 23 September 2021
nd
Dr Noorliyana Marzuki
Dr Meei Yi Ng
Dr Suhaila Mustafa
Department of Paediatric Dentistry
Hospital Tengku Ampuan Afzan
Kuantan, Pahang
Malaysia

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