A 45-year-old male presented to the maxillofacial unit with 1-week's history of dysphagia and a painful tongue. Oropharyngeal examination revealed an ulcerated anterior tongue lesion (top left) with pharyngitis and uvulitis. A tongue biopsy was performed. Histology showed a rich cellular infiltrate extending between muscle fibres (top centre), staining positively for myeloid markers including CD45, myeloperoxidase (MPO) (top right) and CD68. The histological diagnosis was that of a myeloid sarcoma. The full blood count showed haemoglobin 60 g/l, leucocyte count 99 · 10 9 /l and platelet count 27 · 10 9 /l, with the blood film showing promyelocytes. The bone marrow was heavily infiltrated by abnormal promyelocytes and a diagnosis of classical acute promyelocytic leukaemia was confirmed by flow cytometry (MPO + , CD33 + , CD117 + , CD34 ) and HLA-DR ) ) and cytogenetic analysis, with the t(15;17)(q22;q12) translocation being found. All-trans-retinoic acid (ATRA) 45 mg/m 2 and daunorubicin plus cytarabine were started. The patient developed ATRA syndrome 48 h later, with fever, pulmonary infiltrates and pleural effusions. ATRA was temporarily withheld. Dexamethasone 5 mg b.i.d. and broad-spectrum antibiotics were commenced. On day 4, the patient developed worsening dysphagia with purulent oropharyngeal exudates (bottom left). Swabs were persistently negative for organisms and smears showed mature neutrophils. The exudates and the tongue ulcer gradually improved and had completely resolved by day 16.The patient entered complete remission after the first cycle of chemotherapy. A Medline search revealed 38 reported cases of intra-oral myeloid sarcoma. Most were associated with or directly involved bony structures, such as the hard palate and mandible. One case involving the tongue was reported in a patient with a myelodysplastic syndrome. This patient's unusual presentation led to an initial surgical consultation for a presumed tongue carcinoma.The development of self-limiting purulent pharyngeal exudates coincided with ATRA treatment. We postulate that local differentiation of infiltrating promyelocytes in the oropharynx caused the neutrophilic exudates. In vitro incubation of the patient's promyelocytes (bottom centre) with ATRA (bottom right) illustrated this differentiation. The patient has completed chemotherapy and remains well in a cytogenetic and molecular remission at 1 year follow-up.

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