Local management of neutropenic ulcer in a patient under breast cancer treatment

Abstract Neutropenic ulcers are characterized by regular margins with a yellowish membrane, and are usually associated with severe pain and signs of inflammation due to opportunistic infections. Considering the immunosuppressed condition of these patients, local management of these lesions is a challenge. Antimicrobial photodynamic therapy (aPDT) is the association of light, which can be a low-power laser, with a photosensitizing drug and oxygen, whose synergy produces reactive oxygen species capable of reducing non-specific microbial contamination without causing side effects. The aim of this paper is to report a case of oral neutropenic ulcer treated with aPDT. A 50-year-old diabetic woman undergoing breast cancer treatment, presented with a smelly and painful ulcer, which limited her basic oral functions. It was located in the maxillary alveolar ridge in the left first upper molar region and did not present bone involvement. Blood tests showed grade 2 of neutropenia. Thus, conservative treatment with aPDT technique was proposed. After one week, the lesion showed an improvement and pain had halved. The region was totally repaired after three weeks. Local and non-invasive management of these lesions is of utmost importance for immunosuppressed patients, because it avoids systemic side effects and bacterial resistance resulting from overuse of antibiotics.