A mother accompanied with her 1-month and 2-week-old girl reported to the casualty wing of a local referral hospital complaining that her child was experiencing bleeding from the gums after removal of four "plastic teeth" by a local healer a day before. According to her history, the child had been well until a day before (December 8, 2019) when she started crying incessantly for unknown reasons. The following day, she decided to take the child to the nearest clinic for evaluation. However, on her way to the clinic, the mother met a local traditional tooth extractor, and this woman advised her that the cries of the child were due to the presence of "plastic teeth" that needed to be removed for the child to stop crying. The belief by the community is that the prominence seen on gum pads in the areas where canine tooth buds are developing [Figure 1 with arrows pointing to the primary canine bulge], contains "worms" which are the cause of high fever, diarrhea, and vomiting in a child.
After the enucleation of the primary canines, the child started experiencing severe bleeding from the gums, episodes of vomiting blood clots, and voiding black tarry stool that lasted for nearly 15 h, before the decision to seek for medical help from the hospital on December 10, 2019.
At the emergency room of the hospital, enquiry into the baby's past medical history was unremarkable. A review of the antenatal history indicated that the child had been born at 34-week gestation through a cesarean section and had a good "appearance, pulse, grimace, activity, and respiration or APGAR" score. Postnatal history revealed that the child had had no history of treatment for fever or any other infections but had been exclusively breastfed and fully vaccinated and her developmental milestones were normal. On family and social history, the baby was a firstborn, and there was no known history of bleeding disorders in the family.
Initial assessment showed an extremely pale child, who had copious amounts of fresh blood mixed with clots within the oral cavity, and which was cleaned and sucked out from time to time [Figure 2].
There were associated episodes of vomiting clotted blood and voiding of black tarry stool, but no change in urine color. Examination of the abdomen revealed nontender but distended abdomen. Other systems were essentially normal. Local examination of the oral cavity after evacuation of the blood clots showed wounds in all the four quadrants in the canine regions. The nostrils had visible clotted blood. An initial impression was made of severe anemia and septicemia secondary to traumatic teeth extraction. The child was immediately admitted and put on oxygen via nasal prong and antibiotics, and after blood match was done, blood transfusion was commenced, as further investigations continued. A final diagnosis of disseminated intravascular coagulopathy was reached, and the full range of treatment given to the child at the hospital is shown in Table 1. The treatment given to the child was aimed at correcting hemodynamic instability and control of sepsis. However, throughout the admission, the vital signs deteriorated until the child succumbed to the effects of IOM on December 10, 2019, at 12.45 pm, a few hours postadmission. During all this period, it was not possible to obtain an intraoral photograph of the child, and because of the child's loss of blood and eventual death, the final diagnosis of what initially caused the discomfort the child had was never actually elucidated.