Hospital dental management as an adjunct to systemic therapy in refractory oral candidiasis in severe combined immunodeficiency.

OBJECTIVE

To report the clinical impact of structured hospital-based dental management as an adjunct to systemic antifungal therapy in refractory oral candidiasis in Severe Combined Immunodeficiency (SCID).

CASE REPORT: Case report of a 15-month-old male infant with X-linked SCID (IL2RG mutation; T⁻B⁺NK⁻ phenotype) who developed persistent oral and esophageal candidiasis despite prolonged systemic antifungal therapy. A hospital dental protocol was implemented, including systematic mechanical biofilm disruption with saline-soaked swabs and optimized topical nystatin application to enhance mucosal contact time.

RESULTS

Oral candidiasis had persisted for months, causing odynophagia, feeding intolerance, and nutritional compromise. Following 21 days of structured local care, complete resolution of oral lesions was achieved without escalation of systemic antifungal therapy. Clinical improvement included restoration of mucosal integrity and improved feeding tolerance.

CONCLUSION

In SCID, refractory oral candidiasis may reflect biofilm persistence and mucosal immune failure rather than antifungal resistance alone. Targeted hospital-based dental intervention can be decisive in controlling infection and optimizing pretransplant clinical stability.