Case Report - Volume 3 - Issue 1
Oral mucosal burn in a neonate due to accidental wart medicine ıntake
Selin Akyüz Oktay1*; Mehmet Ali Oktay1; Merve Çelenk2
1Department of Child Health and Diseases, Amasya, Turkey.
2Department of Pediatric Surgery, Samsun, Turkey.
Received Date : Jan 25, 2023
Accepted Date : Feb 18, 2023
Published Date: Feb 21, 2023
Copyright:© Selin Akyüz Oktay 2023
*Corresponding Author : Selin Akyüz Oktay, Department of Child Health and Diseases, Suluova State Hospıtal, Amasya, Turkey.
Email: selinakyuz93@gmail.com
DOI: Doi.org/10.55920/2771-019X/1378
Abstract
Caustic ingestion is a problem frequently encountered in children younger than five years of age and mostly in developing countries. It may result in eusophagial, laryngeal, orophanryngeal and oral lesions. An 18 day-old-girl brought to emergency room because she was mistakenly given her fathers’s wart medicine instead of her daily vitamin D medicine. There were severe hyperemia and erosions at her lips, oral mucosa and oropharynx. Her oral nutrition was stopped and intravenous protone pump inhibitor drug has initiated. There were no evidence of gastrointestinal perforation at her abdomen X-ray. Her laboratory test results were completely normal. Endoscopic evaluation was not planned at early period because of her severe oral mucosal lesions. She recieved intravenous methylprednisolone for three days.. An eusophagogastroduedonoscopy was performed on day seven and reported to be normal. She has fully recovered without any sequalea. In this article, incorrect drug use and caustic exposure which are one of the most common household accidents were discussed over a newborn case.
Keywords: Caustic, newborn, mucosal burn
Introduction
Caustic exposure is more common in children than adults, it usually happens accidentally, and seen more often in developing countries and people with low socioeconomic status [1,2]. The risk is increased in children younger than five years of age, especially living in unsafe environment (caustics in unlabeled bottles, drugs within reach, etc) [3].
Caustic ingestion may cause eusophagial, laryngeal, oropharyngeal and oral lesions [4]. It may cause mild mucosal damage as well as severe eusophageal damage and even perforation and death [3]. In this article, incorrect drug use and caustic exposure which are one of the most common household accidents were discussed over a newborn case.
Case
An 18 day-old-girl brought to emergency room because she was mistakenly given her fathers’s wart medicine, containing salicylic acid and 5-flourouracil, instead of her daily vitamin D medicine. There were severe hyperemia and erosions at her lips, oral mucosa and oropharynx (Figure 1). She was restless. Her oral nutrition was stopped and intravenous hydration and protone pump inhibitor drug therapy has initiated. An abdominal radiograph was performed to evaluate eusophageal perforation in which there were no sign of perforation. There were laboratory test results were completely normal. She vomited once through her admission at emergency room. She was admitted to pediatric surgery clinic. Endoscopic evaluation was not planned at early period because of her severe oral mucosal lesions. She did not recieve oral nutrition for three days; on the first day she was given intravenous hydration and following two days total parenteral nutrition. She recieved intravenous methylprednisolone for three days. An eusophagogastroduedonoscopy was performed on day seven and reported to be normal. She has fully recovered without any sequalea
Figure 1: The oral mucosal lesions of the patient.
Discussion
Accidental drug intake and caustic exposure is seen mostly in pediatric age especially in children younger than five years of age. Every year in United States, about 500.000 children are admitted because of toxic substance intake and 5000-150.000 child and adult are reported for toxic esposure [5].
Salicylic acid is one of the most frequently used molecule as analgesic, antipiretic, antiinflammatory drug. Furthermore, it is also used topically for its keratolytic, bacteriostatic and fungicidal effects [5]. The mechanism of corosive damage of topical salicylic acid is not clear but it is known that there is positive correlation between the lenght of exposure and the severity of damage. The damage represents as coagulation necrosis and it recovers through granulation and fibrosis which cause strictures in 2-38% of the patients [5]. We figured the lesions of our case was limited to oral and oropharyngeal mucosa due to low amount of salicylic acid intake.
Examining the case reports in literature with caustic exposure, it has seen that only a few newborn cases were affected and the youngest case reported with caustic damage due to wart medication was our case. There were neonates reported with caustic damage due to other causes that developed eusophagial strictures, required repetitive surgeries and resulted in fatal outcomes [1,5,6].
Altough the opinion that corticosteroids are protective from developing strictures is controversial, there are several studies recommending of its use [1,7]. Our case has recieved methylprednisolone for three days in order to prevent strictures.
The majority of the studies in literature recommended eusophagoscopy to be performed in the first 48 hours after caustic intake. However they also suggested it could be postponed in patients with severe oral mucosal burns [8]. In our case, eusophagoscopy did not performed in the first 48 hours due to her severe oral mucosal burns but she evaluated through eusophagogastroduedonoscopy before discharging from the clinic.
Corosive substance intake is a problem mostly effects children younger than five years of age and especially in developing countries. It is an important public health issue considering its frequency and complications. Parents should be informed about how to use the drugs and warned about that they should read the label of the drug every time it is used and they should keep them somewhere children can not reach. Not only the drugs prescribed to children but also those prescribed to parents might harm children as it is seen in our case. Additionally, along with drugs, detergents, degreasers etc. should also be kept away from children’s reach and they shouldn’t be stored in water bottles or glasses since they could easily be mistaken with drinkable liquids.
References
- Turan, Cüneyt, et al. Corrosive injuries of the esophagus in newborns. Pediatric surgery international. 2000: 16(7): 483-484.
- Contini, Sandro, Alim Swarray-Deen, and Carmelo Scarpignato. Oesophageal corrosive injuries in children: a forgotten social and health challenge in developing countries. Bulletin of the World Health Organization. 2009; 87: 950-954.
- Hurtado, Christine E. Waasdorp, and Robert E. Kramer. Salicylic acid ingestion leading to esophageal stricture. Pediatric emergency care. 2010; 26(2): 146-148.
- Mamede RCM, De Mello Filho FV. Treatment of caustic ingestion: an analysis of 239 cases. Diseases of the Esophagus. 2002; 15(3): 210-213.
- Hurtado, Christine E. Waasdorp, Robert E. Kramer. Salicylic acid ingestion leading to esophageal stricture. Pediatric emergency care. 2010; 26(2): 146-148.
- Bükülmez, Ayşegül, Elif Bilge Kelebek, S. A. R. I. Sinan. Kaza ile Siğil İlacı Verilen Bebekte Koroziv Özofagus Yanığı. Türkiye Çocuk Hastalıkları Dergisi. 2021; 1-3.
- Nuutinen M., et al. Consequences of caustic ingestions in children. Acta Paediatrica. 1994; 83(11): 1200-1205.
- Baskın, Didem, et al. A standardised protocol for the acute management of corrosive ingestion in children. Pediatric Surgery International. 2004; 20(11): 824-828.
