HIV-Related Necrotizing Ulcer Caused by E. Agglomerans: A Case Report

Introduction: Necrotizing ulcerative stomatitis is a rapidly progressive, locally aggressive disease involving both soft and hard tissues. The aetiology is thought to be a combination of infection and immunosuppression.

Case report: A 39-year-old male farmer, attended the clinical department of Infectious Diseases, Contagious Hospital of Henan Province, complaining a papule on his chin which had developed 50 days previously and progressed to a large ulcer following local scratching. He described intermittent fever. Local penicillin injections failed to resolve the lesion. He had been diagnosed HIV-infected 10 years previously, took few drugs over the preceding 10 years and lost 15kg in the previous 6 months. On clinical examination he was pyrexial and cachectic. A deep, asymptomatic, necrotic ulcer 3×3cm2 diameter was on present on the lower labial mucosa with a bloody, purulent discharge. The surrounding tissue was erythematous and swollen. A large necrotic area 4×6 cm2 was present on the chin. The lesion was sharply demarcated from surrounding tissues. The mandibular lymph node were enlarged. The patient’s CD4 count was 38/mm3. Histopathological examination showed chronic inflammation with no malignancy. Bacterial culture showed Enterobacter agglomerans. A definitive diagnosis of necrotizing stomatitis was made. After receiving HAART, anti-fungal, antibacterial, and nutrition support therapies, rinsing the oral lesion, the chin lesion healed. Two months later, the necrotic tissue separated from the patient’s chin leaving a large defect.

Conclusion: Infection with Enterobacter agglomerans is opportunistic secondary to immunosuppression and may result in oro-facial lesions.