Oral dysaesthesia associated with obinutuzumab - a case report

Oral dysaesthesia is a chronic pain condition which can significantly impact patients' quality of life. Due to the multifactorial aetiology of the condition, it can be challenging for both primary and secondary care clinicians to identify and treat all possible causative factors. Comprehensive history taking and focussed chairside examination are imperative in the determination of predisposing factors for oral dysaesthesia.Immunotherapy is a concept in cancer therapy which is becoming the standard of care in the management of certain malignancies. Patients may be well enough to attend general dental appointments while on immunotherapy treatment and therefore increasingly primary care clinicians can expect this cohort of patients under their care.Obinutuzumab is a monoclonal antibody which can be used as a first-line therapy in subsets of non-Hodgkin lymphoma. We present our experience of a patient who suffered severe, therapy-limiting oral dysaesthesia, while undergoing treatment with obinutuzumab for follicular lymphoma. We present the clinical findings and investigations undertaken, which lead to a diagnosis of oral dysaesthesia in this case, and discuss the evidence base surrounding immunotherapy associated with oral dysaesthesia. To the authors' knowledge this is the first reported case of oral dysaesthesia associated with obinutuzumab therapy, but as more patients are treated with novel immunotherapy agents, this may be an important treatment side effect to highlight for future research and dental clinicians' knowledge.