Symptomatic management of a child with cyclic vomiting syndrome.

To cite: Mettu S, Animireddy D, Kanumuri PK, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2016216499 DESCRIPTION Cyclic vomiting syndrome (CVS) is a functional disorder characterised by recurrent, self-limited episodes of intractable nausea and vomiting that are not caused by any specific disease. The episodes occur at variable intervals with prodromal phase of nausea and pallor. The mean age of onset is 3.9 years and the mean number of attacks per year is 4. The aetiology is unknown, but it is possibly because of a dysregulation of the neuroendocrine system, exaggerated cardiovascular responses to postural change and other stimuli that may be associated with the onset of gastrointestinal symptoms. A 27-month-old patient reported to the department of paediatric dentistry with symptoms of swollen gums and loose teeth in the lower front teeth region (figure 1). A detailed history revealed that the patient suffered from repeated episodes of fever and vomiting and was diagnosed with CVS. Blood investigations showed neutropenia, eosinophilia, thrombocytosis and the red blood cells on the peripheral blood smear appeared hypochromatic with anisopoikilocytosis, microcytes and ovalocytes. Intraoral examination revealed generalised inflammation of the attached and marginal gingiva with grade II mobility of 71 and 81. Oral prophylaxis, debridement and irrigation with hydrogen peroxide were performed. Local application of metronidazole gel and sodium monoflourophosphate mouthwash with the importance of oral hygiene maintenance was advised and the patient was recalled after 1 week. The symptoms subsided and patient was instructed to continue the same regimen for a fortnight. On the subsequent visit, the inflammation had drastically come down and there was no mobility of 71 and 81 (figure 2).