A-258 Vincent’s Angina: A Case Report and Retrospective Evaluation of Underdiagnosis in a Brazilian Clinical Setting

Background Vincent’s Angina, also referred to as Necrotizing Ulcerative Gingivitis (NUG), is a destructive necrotizing stomatitis mainly caused by a mixed fuso-spirochetal microbiota. This condition leads to the formation of necrotic ulcers in the interproximal papillae, typically presenting with a white-yellowish or grayish pseudomembrane, accompanied by severe pain and bleeding. Contributing factors include psychological stress, malnutrition, smoking, and immunological disorders, particularly in HIV-positive individuals. The incidence appears higher in young adults and children, often linked to systemic conditions. Despite its continued prevalence, Vincent’s Angina remains insufficiently understood and may be misdiagnosed as a common throat infection. The objective of this study was to report a clinical case of Vincent’s Angina in order to broaden awareness of this frequently overlooked pathology. Methods This case study received ethical approval from a local Research Ethics Committee (approval number 4.335.355). A 43-year-old male presented in May 2020 with tonsillitis, followed by a molar abscess and subsequent tonsil reinfection. Comprehensive clinical examinations were conducted, noting symptom severity and the presence of oral–oropharyngeal lesions. Oropharyngeal swabs were collected using Stuart’s transport medium. Gram staining and optical microscopy were then performed, aiming to identify the presence of fusospirochetal organisms. Additionally, a retrospective review of our laboratory’s database was carried out, encompassing the period from January 2018 to December 2023, to determine the prevalence of Vincent’s Angina diagnoses. Patient history was thoroughly documented, including previous treatments and medical conditions, and photographic records of the clinical manifestations were obtained to support the diagnostic assessment. Results The patient developed a high fever (40°C) lasting four days, accompanied by pronounced pain, malaise, tonsillar erythema, dysphagia, muscle pain concentrated in the upper limbs, oropharyngeal plaques, and adenopathy. Microscopic analysis of the oropharyngeal swab confirmed the presence of fusospirochetal bacilli, consistent with Vincent’s Angina. Treatment consisted of intramuscular ceftriaxone (1 g every 12 hours for seven days), supplemented by a single dose of benzathine benzylpenicillin. The retrospective evaluation identified only 10 confirmed cases over the five-year timeframe, involving patients aged 6 to 63 years. Notably, only three of these cases were explicitly investigated as Vincent’s Angina based on clinical suspicion, highlighting potential underdiagnosis. Conclusion This study underscores the notable underreporting and underrecognition of Vincent’s Angina, likely stemming from limited clinical familiarity and non-specific laboratory requests. The diagnostic uncertainty may lead to false negatives and suboptimal treatment strategies. These findings underscore the importance of broader education among healthcare workers regarding the specific clinical and microbiological features of Vincent’s Angina. Heightened clinical vigilance and targeted diagnostic protocols are essential to ensure timely and accurate identification of this condition, ultimately improving patient outcomes. Enhanced awareness in both clinical and laboratory settings will help mitigate misdiagnosis and facilitate appropriate therapeutic interventions for individuals affected by this pathology.