Next, we researched diabetes. we felt that diabetes mellitus type I was the best diagnosis. For possible causes of diabetes, radiation therapy may have …
Chief Complaint:
David presents a chief complaint of a dry, burning mouth which he has
been experiencing for two weeks The patients other symptoms include:
thirst, recent weight loss, and fatigue In addition, the patient reported
feeling flu-like symptoms and tender glands in his neck nearly six weeks
ago The patient has a history of testicular cancer and was treated with
radiation therapy Upon clinical examination, our findings were a white
covering over the oral mucosa with some redness and inflammation of the
uvula see Attachment 1
Learning Issues:
There were several learning issues that our group researched for this
case including: the significance of the patients systemic symptoms, the
patients oral disease, the causes of a burning dry mouth and thirst,
reasons for weight loss, and the side effects of cancer and radiation
therapy The foremost issue we researched was the patients chief
complaint of a dry, burning mouth and the presentation of an oral disease
Some of the possible causes for his symptoms include: a fungal infection,
either from an opportunistic organism or an acquired one, a
bacterial
infection, a viral infection, and leukoplakia Discussing our findings, we
determined that oral thrush is a likely cause of the patients symptoms
There are two main types of oral thrush The most common type is
pseudomembranous candidiasis, which is caused by Candida albicans and is
presented by white, creamy lesions that scrape off The other type is
erythematous candidiasis, which appears as small, multiple red patches
usually found on the palate or the top surface of the tongue, and
occasionally on the buccal mucosa Since our patient exhibits creamy white
lesions, our group suspects the oral disease to be oral thrush caused by
Candida albicans Based on our research, it could not be determined
whether the infection is viral or bacterial because each type of infection
included other complications
Leukoplakia was also considered Since the patient shows white spot
lesions that are irritable upon touch, heat, certain foods, or other
stimuli, we considered leukoplakia as a possible condition Leukoplakia
may be caused by a disorder of the oral mucosa, smoking,
an
immunocompromised condition, or from irritable dental restorations
However, the diagnosis of leukoplakia was easily eliminated with further
research because that is normally found in older patients who use tobacco
Also, this is usually found on the tongue, which is not true in Davids
case
Since we began to suspect Candida albicans as the possible cause for
the patients oral disease, we researched how this yeast of the normal
flora causes infection We found that immunocompromised patients were at
the highest risk level As a part of the normal flora, Candida albicans
resides on and inside the surfaces of every human and therefore is easy for
people to be exposed to it Healthy immune function maintains low amounts
of yeast in a persons mouth and thus, this is usually not a communicable
disease
Since David is a survivor of testicular cancer and recovered from
radiation therapy, we researched how this may affect the immune system We
found that since radiation therapy was finished one year ago, it is not
likely that the immune system is still affected by this
Next, we investigated the possible cause of his
flu-like symptoms
Since the symptoms have occurred over a prolonged period, we began to
suspect a possible HIV infection since onset symptoms of HIV are flu-like
We found that oral thrush is a possible condition that presents in HIV and
AIDS patients due to their immunocompromised condition, thus leading to the
opportunistic infection by Candida albicans
Finally, we looked into the facts of weight loss and significant
thirst We found that patients with AIDS suffer from significant weight
loss, but we were unable to find significant facts suggesting thirst as
well In this case, we looked up diabetes as being a possible factor
Weight loss, thirst, and infections were all possible in patients with
poorly controlled diabetes
Diagnosis:
Upon receiving the patients culture results from an oral swab, it was
determined that the infection was Candida albicans, thus indicating oral
thrush We researched reasons why normal flora would be present in an
infection We suspected that the patient must have an immunocompromised
condition Some immunocompromised conditions researched include: HIV,
AIDS, and diabetes
mellitus
HIV and AIDS were considered first, but this diagnosis was eliminated
for many reasons Since David visited his physician within the last year,
it is likely that if he has AIDS, he would have suspected other symptoms
sooner and his physician would have completed certain blood tests or even
HIV tests Also, the gap between the onset of possible HIV symptoms,
Davids flu-like symptoms, and his opportunistic infection was too short
Normally, the onset of HIV and the progression to AIDS takes years, not the
6 weeks reported by the patient We felt that if David did have HIV, it
would have been noticed while doing radiation therapy, as blood work and
close monitoring are required to do such
Next, we researched diabetes Patients with diabetes mellitus
commonly exhibit symptoms of fatigue, weight loss, and lowered immune
responses This corresponds to Davids symptoms of weight loss and lowered
immune responses flu-like symptoms over last few months Also, diabetes
can cause various skin problems in many individuals with diabetes including
bacteria infection, fungal infection, and itching We found that one of
main
causes of fungal infection in patients with diabetes is Candida
albicans, which was found in Davids case Based on our research, we felt
that diabetes mellitus type I was the best diagnosis For possible causes
of diabetes, radiation therapy may have resulted in the destruction or
reduction of insulin-production and thus caused diabetes Alternatively,
David may have just begun to express the signs of disease mellitus because
type I diabetes can have late expression, even in young adults like David
To be sure, we would need results for different tests Some tests that will
be useful are urine sugar/ketone tests, a blood glucose test, and
especially Glutamic Acid Decarboxylase GAD antibody tests which are
specific for type I, since we suspect type I diabetes mellitus
Treatment:
First, we would treat Davids oral thrush, addressing his chief
complaint We researched various topical treatments and oral systemic
medications to be administered in the form of a pill, oral rinse, or
lozenge that may successfully eliminate the oral thrush Topical
treatments include: topical antifungal treatment using
Mycelex troches or
Nystatin rinses We also researched Diflucan, a systemic treatment that is
administered in the form of a pill
The oral rinses and lozenges contain sugar and thus would not be the
best treatment for a patient with diabetes mellitus Although topical
treatments have been found to be the best treatment, they require doses at
a high frequency Therefore, self-administration of these treatments may
not be appropriately followed
Diflucan does not contain sugar and allows for better patient
compliance since it is a pill and fewer doses are needed for treatment
Diflucan has caused serious liver problems in rare cases, but since liver
problems were not mentioned as a medical issue for the patient, this
mediation should suffice
Finally, we would refer David to his primary physician for an
examination, possible lab tests, and consultation to discuss diabetes
mellitus type I His physician could then provide treatments for this
condition
Literature
Cited
http://wwworalhivlesionscom/adultshtm
http://wwwbiology-onlineorg/biology-forum/about2921html
http://wwwdiabetesorg/for-parents-and-kids/what-is-diabetes/skin-
complicationsjsp
http://wwwwrongdiagnosiscom/d/diabetes/testshtm
http://wwwdrugscom/diflucanhtml
http://pathmicromedscedu/mycology/opportunistichtm
Little, JW; Falace, DA; Miller, CS; Rhodus, NL Dental Management of the
Medically
Compromised Patient
ATTACHMENT 1
Source:chej.org
