Work

Acute myeloid leukemia presenting with gingival enlargement masked by a normal complete blood count: A case of delayed diagnosis and literature review

Year: 2025

Type: article

Abstract: RATIONALE: Acute myeloid leukaemia (AML) is a lethal hematological malignancy whose oral manifestations are frequently misdiagnosed as inflammatory periodontal disease. This case exemplifies the diagnostic challenges associated with AML, particularly when initial blood counts appear normal and conventional periodontal treatment proves ineffective. PATIENT CONCERNS: A 45-year-old male patient presented with a 3-month history of progressive gingival bleeding, swelling, and occlusal discomfort. DIAGNOSES: The preliminary hematological analysis yielded no significant findings. Not with standing the implementation of conventional periodontal therapy, the gingival enlargement exhibited a marked exacerbation, manifesting as a soft, lobulated appearance. A subsequent hematological workup revealed thrombocytopenia (68 × 109/L). Bone marrow aspiration confirmed the diagnosis of AML with 81% myeloblasts. INTERVENTIONS: The patient received periodontal initial therapy and "7 + 3" induction chemotherapy regimen (cytarabine + daunorubicin). OUTCOMES: The chemotherapy resulted in significant regression of the gingival enlargement. However, the patient passed away 5 months after diagnosis. LESSONS: This case underscores the notion that gingival enlargement can serve as an initial indicator of AML, even in the absence of conventional hematological abnormalities. Dentists are required to exercise a high level of suspicion regarding systemic etiologies when confronted with severe, refractory, or rapidly progressive gingival enlargement that is disproportionate to local irritants. It is imperative that patients consult with hematologists at the earliest opportunity, and that repeated hematological evaluations are carried out in order to prevent misdiagnosis and delays in life-saving treatment.

Source: Medicine

DOI: 10.1097/md.0000000000046684

Authors: Dandan Wu, Wenxiu Li, Liang Luo, Fugen Ding

Institution: Guiyang Medical University

Language: English

Topic: Oral and gingival health research

Subfield: Pharmacy

Field: Health Professions

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,950