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Chronic Mucocutaneous Candidiasis: A Case Report.
BHOWATE Ra, DUBEY Ab
ABSTRACT can be made based on clinical findings. Microscopy and
Chronic mucocutaneous candidiasis is a immuno deficiency disorder culture of skin swabs and scrapings confirms the presence
primarily due to T cell dysfunction characterized by persistent
of microorganisms. Serum values for various endocrinopathies
candidal infection of mucous membrane, skin, scalp and nails. 8
Chronic mucous membrane candidiasis has an onset in infancy or formulate an important key to diagnosis .
childhood; the primary affected site is the oral cavity; however, lesions
may occur on trunk, hands, feet and scalp. This paper describes a 12- CASE REPORT
year-old girl with candidial infection of the oral mucosa and extra oral
involvement of fingers, nails, toes and intertragus area.
A 12-year-old female patient reported to the Department of
Pedodontics Govt. Dental College Raipur with the complaint
Keywords: Autoimmune, Moniliasis, Polyendocrinopathy,
Thrush. of broken maxillary anterior tooth. She wanted to replace the
same with an artificial tooth. Intra oral examination revealed
INTRODUCTION carious maxillary anteriors and premolars, bilaterally. Soft
tissues examination revealed white curd like lesions scattered
Chronic mucocutaneous candidiasis (CMC) is the term used all over the buccal mucosa (Fig 1), upper and lower labial
to describe a rare, heterogeneous group of syndromes in mucosa (Fig 2), palatal mucosa (Fig 3) and dorsal surface
which affected individuals with congenital, endocrinological of tongue with loss of papillae and prominent central groove
or immunological disorders develop recurrent or persistent (Fig 4). The hands and feet showed scaly lesions with
mucosal, cutaneous or nail infections with Candida albicans. involvement of intertrigenus area and nails (Fig 5 and 6). Nails
Chronic mucocutaneous candidiasis is associated with were markedly thickened, fragmented and discolored with
endocrine conditions like hypoparathyroidism, significant edema. Erythema of the surrounding periungal
hypothyroidism, hypoadrenalism and diabetes mellitus . tissue simulating clubbing was also present. Scrapping from
Immune defects i.e. malfunctioning of lymphocytes, low levels the lesion revealed the presence of Candida albicans.
of immunoglobulin is also a contributory factor . Rarely chronic Laboratory investigations revealed Hb 8gm%, total leukocyte
mucocutaneous candidiasis develops in adult life. This is count 3500 / cu mm, ESR 35mm at the end of one hour
often as a result of a thymoma (tumor of thymus gland) and (Westergen method). T3, T4, TSH and liver function tests
is associated with internal disease such as myasthenia gravis, were within normal limits. Patient was medicated with
myositis, aplastic anaemia and neutropenia. Patient presents ketoconazole 150 mg systemically along with topical
with a history of recurrent or persistent superficial infections application for 12 weeks. Carious broken maxillary teeth and
of the oral cavity (thrush), intertriginous or perioro-facial root pieces were extracted and replaced with a removable
structures. Infants often present with candidial diaper space maintainer. Patient responded well to the therapy and
dermatitis . These infections can be followed by more oral lesions disappeared completely after six weeks. Finger
extensive scaling of skin lesions, as well as thickened nails nails and toe lesions started healing after 10 weeks of therapy.
and red swollen periungal tissues . The scalp may be involved After 12 weeks, patient was asked to continue with
with similar hyperkeratotic plaques, which can result in ketoconazole once in a week for next six months. The patient
scarring and alopecia . was followed upto two years without recurrence.
Some patients with chronic mucocutaneous candidiasis have
an associated abnormality of iron metabolism demonstrated DISCUSSION
by low serum iron and decreased iron stores . These
abnormalities may be caused by decreased iron absorption. Chronic mucocutaneous candidiasis is a heterogeneous
Provisional diagnosis of chronic mucocutaneous candidiasis disorder of immune system characterized by infection of
mucous membrane, scalp, skin and nails. Familial CMC may
a.Principal, b.Assistant Professor, Dept. of Pedodontics & Pre- be associated with autoimmune polyendocrinopathy . Most
ventive Dentistry, Govt. Dental College and Hospital, Raipur, patients with CMC have a selective defect of cell-mediated
Chronic Mucocutaneous Candidiasis
Fig 1: Clinical photograph showing candidial lesions Fig 2: Clinical photograph showing candidial lesions
on atrophic buccal mucosa. on labial mucosa.
Fig 3: Clinical photograph showing candidial lesions Fig 4: Clinical photograph showing depapillation of
on palatal mucosa with carious 11 & 21. tongue with central groove & candidial lesions.
Figs 5 and 6: Clinical photograph showing markedly thickened nails, scaly lesions of hand and feet,
erythema of surrrounding periungal tissue, simulating clubbing.
Chronic Mucocutaneous Candidiasis
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