Noma Cancrum Oris in Taiwan During the COVID-19 Pandemic Era - A Case Report

壞疽性口炎再現於台灣之嚴重特殊傳染性肺炎疫情期間──案例報告

Yi-An Wu(吳薏安) ； Kuo-Feng Huang(黃國峯) ； You-Cheng Lin(林祐丞)

《臺灣整形外科醫學會雜誌》 32卷2期 (2023/06) Pp. 174-180

摘要

Background: Necrotizing ulcerative stomatitis, also known as Noma cancrum oris (Noma), is an aggressive soft tissue infection of mouth which mostly affects malnourished children living in underdeveloped tropical countries. In developed country, such as Taiwan, noma has been almost eradicated. However, it was found during COVID-19 era. Aim and Objectives: We presented a rare case of noma on an otherwise healthy middle-aged female during COVID-19 pandemic in Taiwan. Materials and Methods: A 54-year-old female who had no underlying disease was presented to our hospital with severe necrotic ulceration in the perioral region. The final diagnosis was noma. There was no predisposing factor for this patient except the delay of medical help because of social distancing due to COVID-19 and fear of contagion. Results: Perioral infection was controlled after antibiotic treatment and aggressive wound care. Soft tissue defect was then reconstructed with Estlander and nasolabial flaps. Conclusion: Despite treatment delayed by the pandemic, satisfactory functional and aesthetic outcome is still achievable for noma with timely antibiotic treatment, debridement, and soft tissue reconstruction.

關鍵字

noma ； necrotizing ulcerative stomatitis ； COVID-19 ； Eslander flap ； nasolabial flap

並列摘要

背景：壞疽性口炎好發於開發中國家，營養不良的孩童，發生的原因迄今不明，可能肇因於齒源性感染；加上營養不良、免疫力低下，以及口腔衛生不佳等狀況加劇感染導致。台灣全民健保及醫療院所密度高讓民眾就醫便利性極高，但在嚴重特殊傳染性肺炎（COVID-19）期間因疫情恐懼，改變了病患就診意願及習慣。目的及目標：在嚴重特殊傳染性肺炎期間，無過去病史的中年女性因疫情焦慮擔心就醫時染易而延後就醫，致使壞疽性口炎的罕見案例。材料及方法：54歲中年女性，因右唇及右頰組織缺損及感染至急診就醫。檢查後發現缺損組織包含右唇附近區域及黏膜全層壞死，診斷為壞疽性口炎（noma）。患者無任何致病因子，唯有因嚴重特殊傳染性肺炎（COVID-19）的疫情期間的管制站人流及醫療院所人流，導致患者不敢就醫，延誤了初期的治療，最終形成壞疽性口炎。結果：經過抗生素及持續之換藥治療，再加上使用Estlander皮瓣及鼻唇溝皮瓣修補組織缺損，病患口部功能、外觀及嘴角完整性追蹤過程恢復良好。結論：儘管病患因疫情焦慮延誤診斷及治療，及時的抗生素治療、清創及後續的重建是讓病患得到美觀及功能恢復的關鍵。