Sir, I am writing this letter in regards to a 5-year-old patient who presented in our Oral Maxillofacial Department, with a history of recurrent oral ulcerations. The patient was referred in by their general medical practitioner due to ulcers that had occurred in the mouth every six weeks. The ulcers lasted for a few days and had been an ongoing problem for three years. The patient's mother mentioned that the oral ulcers seemed to coincide with malaise, fatigue and with the patient generally feeling ill and run down whilst the oral ulcers were present. Other than this, the patient's medical history was unremarkable. Extraoral examination was also unremarkable but intraorally, the patient had slightly inflamed gingivae, with sites of recovering ulcers.

In order to help diagnose the cause of the ulceration, it was decided that it was necessary to arrange for a blood test to be taken. However, it was not just the one blood test that would be performed, but a series of blood tests every week for six weeks. The patient returned for a review appointment along with the blood test results after this period. Five of the six weeks showed normal blood test results; however, on one of the weeks there was a marked decrease in the neutrophil count, and this coincided with the patient presenting with oral ulcers and feeling fatigued.

Based on the history and the blood results, a diagnosis of cyclic neutropenia was made.

This rare condition was explained to the patient's parent and the patient was referred back to the general medical practitioner in order to have appropriate treatment in order to combat the deficiency in neutrophils that occur in a regular occurrence. The patient was advised to use Orabase, which helped alleviate the symptoms caused by the ulcers, as and when they occurred.

Cyclic neutropenia is a rare variant of neutropenia, and is a condition characterised by a marked decrease in circulating neutrophils in the peripheral blood, occurring in a cyclic fashion every three to six weeks. Some of the oral symptoms that have been reported in this condition include ulcers,1 gingivitis, periodontitis2 and even tooth loss.3 The best way to diagnose the condition is to have a series of routine blood tests which would show the decrease in neutrophils.

Although cyclic neutropenia is rare, it is fairly simple to diagnose and this case highlights the importance of how a history can help point the general dental practitioner in the right direction and the importance of the weekly blood tests in order to confirm the diagnosis. It is vital the GDP helps the patient understand the importance of good oral hygiene in this condition and although the condition requires the GMP to treat this condition, it signifies the importance of working with other health professionals in order to provide a high standard of care for the patients.