Description
A male in his 70s, with no known comorbidities or history of substance abuse, presented
with complaints of abdominal discomfort and dyspepsia. Despite being prescribed proton
pump inhibitors, his symptoms persisted. An upper gastrointestinal endoscopy revealed
a gastric ulcer. Histopathological examination of the biopsy confirmed a diagnosis
of moderately differentiated adenocarcinoma stomach. A positron emission tomography
PET scan showed hypermetabolic, asymmetrical, circumferential wall nodular thickening
involving the medial wall of the antropyloric region of the stomach, along with hypermetabolic
enlarged perigastric lymph nodes. The patient was started on perioperative chemotherapy
as per the FLOT (5-fluorouracil/leucovorin, oxaliplatin, and docetaxel) protocol.
After completion of four cycles of chemotherapy, he underwent surgery. He was then
started on postoperative adjuvant chemotherapy.
Following six cycles of chemotherapy, discoloration of the patient's teeth was observed.
Specifically, yellow-black discoloration was noted on the lower teeth, and yellowish
discoloration on the upper incisors ([Fig. 1 ]) of the patient. The patient was not taking any additional medications and denied
any history of tobacco use. What can be the differential diagnosis?
Fig. 1 Left: presence of yellow-black discoloration in the lower teeth (arrowhead). Right:
yellowish discoloration in the upper incisors (arrowhead).
After completion of a total of eight cycles of chemotherapy as planned, he was then
advised to have 3 monthly follow-up. At his 3-month review, the discoloration had
partially resolved, implying chemotherapy to be the causative agent. ([Fig. 2 ]) While chemotherapy-induced tooth discoloration has been previously reported, such
occurrences remain relatively rare.[1 ]
[2 ]
[3 ] Discoloration of teeth and enamel hypoplasia may result from chemotherapeutic agents
like vincristine, vinblastine, and cyclophosphamide, which can interfere with ameloblast
activity, particularly by disrupting their microtubule-dependent calcium transport
systems.[4 ] This is a rare case of FLOT chemotherapy-induced tooth discoloration. Clinicians
must remain vigilant for this adverse effect while administering this chemotherapy
regimen to patients.
Fig. 2 Left: showing resolution of discoloration in the lower teeth 3 months post last chemotherapy.
Right: showing resolution of yellowish discoloration in the upper incisors 3 months
post last chemotherapy.
