Noma in an unusual case of perforated appendicitis with pneumoperitoneum

Noma is a very rare gangrenous infection of the oral cavity usually associated with debilitating diseases, immunosuppression, or malnutrition. Its development in a previously healthy 13-year-old boy with perforated appendicitis is presented. Streptococcus bovis type II and E coli were isolated from the noma and Streptococcus bovis, Bacteroides fragilis, and Bacteroides asacharolyticus from the peritoneal fluid. A transient impaired immune cellular function was found and may have contributed to the development of the noma in this child.