PMC4415315_01
Findings on admission. A) Left mandible with denudation of bone, spontaneous loss of the teeth, necrotizing gingivitis and stomatitis. B) Orthopantomography show ill-defined, irregular bony destruction in the left mandible. C) Gallium-67 citrate scintigraphy shows abnormal uptake in the left mandible.
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Fig1
Intraoral examination showed necrosis of the left mandible with exposed bone, a missing right mandibular canine tooth, necrotizing gingivitis and stomatitis that had destroyed the buccal mucosa and floor of the mouth (Figure 1A). Orthopantomography showed ill-defined, irregular bony destruction on the lower alveolar ridge extending from the left canine tooth to the left second molar, with floating teeth at the right canine and first premolar in the right mandible (Figure 1B). Gallium-67 citrate scintigraphy showed abnormal uptake in the left mandible (Figure 1C).
Changes in appearance on 3D-CT from on admission. (A) to the 2-month follow-up examination (B). A) 3D-CT showed ill-defined, irregular destruction of cortical bone in the left mandible on admission. B) Sequestra of the mandible were seen as radiopaque areas resembling "islands of bone" at the 2-month follow-up.
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Fig2
Three-dimensional (3D)-CT showed destruction of cortical bone in the left mandible (Figure 2A). At the 2-month follow-up, necrotic bone of the mandible was seen as radiopaque areas resembling "islands of bone" on both orthopantomography and 3D-CT (Figure 2B).
Appearance at the 6-month follow-up examination. In the absence of radical surgery, spontaneous exfoliation of sequestrum is observed, showing spontaneous expulsion through the mucosa. A) Extensive scarring is seen around the mandibular defect. B) On 3D-CT, the living bone is seen to be very thin in the left mandible.
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Fig3
Extensive scarring was seen around the mandibular defect (Figure 3A). CT showed that living bone was very thin in the left mandible, with a risk of pathological fracture due to a significant volume of bone loss (Figure 3B).
Treatments and changes in HIV-RNA viral load and CD4 count. Viral load decreased from 2.5 x 105 copies/mL to <44 x 105 copies/mL with treatment. During the first 10 months after treatment, CD4+ lymphocyte count increased from 78 cells/muL to 280 cells/muL.
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Fig4
Ten months after starting HAART, the CD4+ lymphocyte count had increased from 78 cells/muL to 280 cells/muL (Figure 4).