SHM Converge Scientific Abstract ePoster Gallery-Time Is Gum: Rapid Recognition of Epstein Barr Virus Associated Necrotizing Ulcerative Gingivitis in an Immunocompetent Patient

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This case report describes a rare presentation of acute necrotizing ulcerative gingivitis (NUG) in a previously healthy 19-year-old woman with recent Epstein-Barr virus (EBV) infection. She presented with several days of sore throat, fever, severe oral pain, and gray-black gingival discoloration. Examination showed necrosis of the interdental papillae and pseudomembranous changes consistent with necrotizing gingivitis. Initial labs demonstrated leukopenia with marked neutropenia, elevated inflammatory markers, and positive EBV serologies.<br /><br />Because she also had a new systolic murmur, cytopenias, and mucosal necrosis, the differential diagnosis was broad and included leukemia, infective endocarditis, autoimmune disease, viral marrow suppression, and superimposed bacterial infection. She was admitted for multidisciplinary evaluation and empiric broad-spectrum antibiotics. Echocardiography suggested incidental hypertrophic cardiomyopathy rather than endocarditis, and hematology favored transient viral marrow suppression rather than leukemia. Infectious and rheumatologic workups were unrevealing, and CT imaging showed no abscess or deep space infection.<br /><br />With other causes excluded and gingival necrosis worsening, the team diagnosed EBV-associated necrotizing ulcerative gingivitis, likely due to temporary immune dysfunction from EBV-related neutropenia. She was treated with chlorhexidine rinses, metronidazole, and same-day outpatient periodontal debridement by oral and maxillofacial surgery, resulting in complete symptom resolution.<br /><br />The authors emphasize that NUG can occur even in immunocompetent patients after physiologic stress or viral illness. Early recognition is critical because the condition can progress rapidly and cause significant tissue destruction if untreated. Multidisciplinary care and prompt local debridement are key to recovery.

Asset Subtitle

Saja Ibrahim

Meta Tag

Author List Minisha Lohani, Saja Ibrahim, Vivian Dong

Category Clinical Vignettes

Concept Acute Necrotizing Gingivitis

Concept Oral Pain

Concept Oral Necrosis

Concept Gingival Discoloration

Concept Gingival Bleeding

Distinguished Non-Finalist

Presenter Organization University of Virginia School of Medicine

Presenting Author Saja Ibrahim

Track Adult

Keywords

acute necrotizing ulcerative gingivitis

EBV infection

necrotizing gingivitis

gingival necrosis

neutropenia

leukopenia

oral pain

chlorhexidine rinse

metronidazole

periodontal debridement

Acute Necrotizing Gingivitis

Oral Pain

Oral Necrosis

Gingival Discoloration

Gingival Bleeding