Hindawi Publishing Corporation International Journal of Dentistry Volume 2009, Article ID 654239, 6 pages doi:10.1155/2009/654239 Case Report The Effect of Recombinant Granulocyte Colony-Stimulating Factor on Oral and Periodontal Manifestations in a Patient with Cyclic Neutropenia: A Case Report Sergio Matarasso, Vincenzo Daniele, Vincenzo Iorio Siciliano, Michele D. Mignogna, Gianmaria Andreuccetti, and Carlo Cafiero Department of Odontostomatological and Maxillo-Facial Science, The School of Medicine and Surgery, Federico II University of Naples, Italy Correspondence should be addressed to Carlo Cafiero, c.cafiero@unina.it Received 4 May 2009; Revised 28 July 2009; Accepted 30 November 2009 Recommended by Jasim M. Albandar Cyclic Neutropenia (CN) is characterized by recurrent infections, fever, oral ulcerations, and severe periodontitis as result of the reduced host defences. The previous studies have established the effectiveness of recombinant granulocyte colony-stimulating factor (GCSF) to increase the number and the function of neutrophils in the peripheral blood in this disease. In a 20-year-old Caucasian female with a diagnosis of cyclic neutropenia, oral clinical examination revealed multiple painful ulcerations of the oral mucosa, poor oral hygiene conditions, marginal gingivitis, and moderate periodontitis. The patient received a treatment with G-CSF (Pegfilgrastim, 6 mg/month) in order to improve her immunological status. Once a month nonsurgical periodontal treatment was carefully performed when absolute neutrophil count (ANC) was ≥500/μL. The treatment with G-CSF resulted in a rapid increase of circulating neutrophils that, despite its short duration, leaded to a reduction in infection related events and the resolution of the multiple oral ulcerations. The disappearance of oral pain allowed an efficacy nonsurgical treatment and a normal tooth brushing that determined a reduction of probing depth (PD ≤ 4 mm) and an improvement of the oral hygiene conditions recorded at 6-month follow-up. Copyright © 2009 Sergio Matarasso et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 1. Introduction Neutrophils play a critical role in the host defence mech- anism against bacterial infections [1]. There are 3 general guidelines used to classify the severity of neutropenia based on the absolute neutrophil count (ANC) measured in cells per microliter of blood: (i) mild neutropenia (1000 ≤ ANC < 1500)—minimal risk of infection, (ii) moderate neutropenia (500 ≤ ANC < 1000)— moderate risk of infection, (iii) severe neutropenia (ANC < 500)—severe risk of infection. The above mentioned ranges were developed in Cau- casians. In colored population, mild neutropenia is a normal phenomenon, and neutropenia in this population is more properly defined as ANC < 1200. Higher cutoffs may lead to overdiagnosis of neutropenia in the colored population [2]. The clinical consequence of the disease is an increased infective diathesis proportional to the severity of the neu- tropenia. Several forms of neutropenia (agranulocytosis, familiar benign neutropenia, severe chronic neutropenia) can be found associated with oral manifestations. Severe chronic neutropenia is characterized by a selective decrease in circulating neutrophils and includes a heterogeneous group of haematological diseases divided into three main syndromes: idiopathic neutropenia, congenital forms of neutropenia, and cyclic neutropenia. The present paper is aimed at evaluating the efficacy of a non surgical periodontal treatment associated with G-CSF therapy in a patient suffering from cyclic neutropenia (CN)