*3.3.2 Clinical manifestations*

The signs and symptoms of CN usually appear at birth or shortly after, and the major clinical problem associated with neutropenia is recurrence of bacterial infections. Opportunistic infections can occur during ANC reduction, with the main clinical manifestations of fever, malaise, headache, anorexia, pharyngitis, tonsillitis, skin infections (**Figure 10**), and swollen lymph nodes, sepsis, ulcers of the oral mucous membrane (**Figure 11**), periodontal inflammation and severe periodontitis (**Figure 12**). when ANC <500/μL for more than 7 days within the cycle, patients regularly have painful mouth ulcers, upper respiratory tract infections, skin abscesses, and suffer from malaise, whereas severe infections are very rare. Oral manifestations usually occur around early childhood, systemic symptoms, such as fever, generally diminish after adolescence, but adults with CN continue to experience oral ulcers, gingivitis, and periodontitis [52, 58].

**Figure 10.**

*Scar formation after slow healing skin infections with a Chinese male (25 years old) with cyclic neutropenia (CN).*

**Figure 11.** *Oral ulcers in the Chinese male (Figure 10) with CN.*

**Figure 12.** *Oral manifestations of the CN patient (Figure 10) with serious periodontitis.*
