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104:The Use Of Thalidomide In The Treatment Of HIV-related Oral Ulceration[AAOM2021]
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Poster Title: 104:The Use Of Thalidomide In The Treatment Of HIV-related Oral Ulceration[AAOM2021]
Submitted on 29 Mar 2021
Author(s): Vignesh Murthy, Katherine Eccles, Helen McParland, Pepe Shirlaw, Rui Albuquerque, Barbara Carey
Affiliations: Department of Oral Medicine, Guy's & St Thomas' NHS Foundation Trust/ King's Health Partners, Guy's Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom
This poster was presented at 2021 American Academy of Oral Medicine Virtual Conference
Poster Views: 59
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Poster Information
Abstract: Background:

The prevalence of HIV-related oral ulceration varies from 5-10 % globally. Thalidomide has been used as an off-licence medication in managing HIV-related oral ulceration since the late 1990s. Whilst the exact mechanism of action of thalidomide is unknown, modulation of the inflammatory cascade and interaction with various cytokines, such as tumour necrosis factor-α are believed to be involved. Thalidomide is used in the management of recalcitrant ulceration that proves refractory to alternative systemic and topical therapies. The adverse effects include teratogenicity, peripheral neuropathy and thromboembolic disease, limiting its use. Here we present two cases of HIV-related oral ulceration treated with thalidomide.

Case Summaries:

Case 1

A 35-year-old male was referred with a 14 year history of HIV-related oral ulceration. The Ulcer Severity Scores (USS) at presentation was 38. The patient failed to respond to a number of topical and systemic agents for an 8-month period. Baseline EMG was normal. He was treated with thalidomide over 5 years, with spontaneous resolution of ulceration eventually reported. The USS 3 and 6 months after treatment commenced was 10 and zero, respectively.

Case 2

A 56-year-old female was referred with 1-year history of HIV-related oral ulceration. The USS on presentation was 28. The patient failed to respond to topical therapy for 1 year. The patient had a baseline neuropathy of her lower limbs. Treatment was stopped after 3 months due to worsening neuropathy, despite her USS reducing to zero, 3 months after commencing treatment.

Conclusion:

These cases highlight the usefulness of thalidomide in HIV-related oral ulceration, whilst also demonstrating the adverse effect associated with its use. Thalidomide may be preferred in recalcitrant cases over traditional immunosuppressive agents. Clinicians should be aware of the risk of worsening neuropathy by co-prescribing thalidomide in HIV patients. It has been suggested that thalidomide should not be used in those with preexisting HIV-related peripheral polyneuropathy or polyradiculopathy. Regular clinical review, EMG and haematological investigations facilitate the safe use of thalidomide. These cases also highlight the benefit of an objective clinical scoring tool in monitoring response to treatment.
Summary: Here we present two cases of HIV-related oral ulceration treated with thalidomide.

Ask the author questions about this poster:vigimurthy@gmail.com
References: 1.JacobsonJM,GreenspanJS,SpritzlerJ,etal.Thalidomideforthetreatmentoforalaphthousulcersinpatientswithhumanimmunodeficiencyvirusinfection.NewEnglJMed1997;336:1487-1493.
2.BallSC,SepkowitzKA,JacobsJL.Thalidomidefortreatmentoforalaphthousulcersinpatientswithhumanimmunodeficiencyvirus:casereportandreview.AmJGastroenterol1997;92:169-170.
3.ShettyK.ThalidomideintheconcurrentmanagementofrecurrentaphthousulcerationsandKaposisarcomainHIVpatientswithsevereimmunosuppression.OralOncolExtra2006;42:26-31.
4.HarteMC,SaunsburyTA,HodgsonTA.Thalidomideuseinthemanagementoforomucosaldisease:A10-yearreviewofsafetyandefficacyin12patients.OralSurgOralMedOralPatholOralRadiol2020Oct;130(4):398-401.
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