Clinical case of noma in the context of severe immunodeficiency due to HIV infection

Abstract

This article describes a clinical case of successful treatment of noma (cancrum oris) in a 51-year-old female patient with late-stage HIV infection. An extensive ulcerative-necrotic lesions of the soft tissues of the lower lip and chin developed against the background of severe immunodeficiency (CD4 count: 25 cells/μL, viral load: 22.4 million copies/ mL). Microbiological testing identified polymicrobial infection with Fusobacterium spp., Staphylococcus aureus, and Candida albicans. A comprehensive treatment strategy included antibacterial and antifungal medications, symptomatic care, nutritional support, and antiretroviral therapy. This approach led to complete clinical recovery of the affected skin restoration without the need for surgical intervention. At six months post-treatment initiation, sustained immunological and virological remission was achieved (CD4 count: 425 cells/μL, viral load: 36 copies/mL). Six months after the initiation of therapy, the patient achieved sustained immunological and virological remission (CD4 count: 425 cells/μL; viral load: 36 copies/mL). This case underscores the importance of timely initiation of ART and an integrated approach to managing severe opportunistic infections in people living with HIV.