Oral Manifestation as the Main Sign of an Advanced Stage Acute Promyelocytic Leukemia

Abstract

Acute myeloid leukemia is an aggressive malignant neoplasm occurring mainly in elderly, with the median age of 65 years. Oral manifestations, mainly spontaneous bleeding, are a common finding in acute myelocytic leukemia and may represent the initial evidence of the disease. This report describes a case of a 47-year-old man with a one-month history of spontaneous oral bleeding. The patient had already been consulted by two professionals but he remained undiagnosed. The physical examination revealed paleness, fever, epistaxis and ecchymoses in the oral mucosa. The complete blood count revealed anemia, severe thrombocytopenia and leukocytosis with blasts predominance, reinforcing the diagnosis hypothesis of an acute leukemia. The patient was immediately referred to the Hospital and despite having received a quick intervention, he died 3 days after the admission due to diffuse pulmonary alveolar hemorrhage. According to the peripheral blood immunophenotyping the diagnosis of hypogranular variant of acute promyelocytic leukemia was established. The delay in the diagnosis may have influenced the unfavorable outcome. Early diagnosis and management are indispensable for survival of leukemia patients. In this way, dentists may be responsible for an early detection of oral manifestations of leukemia and for a fast referral to an adequate professional.

Oral manifestations of leukemia as part of early diagnosis

“…The oral MOLs were in gingival tissue (63.63%), 9 , 12 , 17 , 18 , 19 , 21 , 23 , 24 , 25 , 26 , 27 , 30 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 15 , 40 alveolar and jugal mucosa (18.18%) 14 , 18 , 21 , 22 , 26 , 28 and hard or soft palate (18.18%). 9 , 11 , 15 , 16 , 27 , 30 Other regions, such as the floor of the mouth (12.12%), 13 , 16 , 23 , 38 tongue (9.09%), 13 , 33 , 39 lip (3.03%), 13 parotid glands (3.03%), 10 and nasolabial region (3.03%), 26 were less frequent.…”

“…The blood count was the main blood test requested to help support the presumptive diagnosis of an oral MOL. Thrombocytopenia was present in 22 cases (59.09%), 9 , 10 , 24 , 25 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 12 , 39 , 40 , 14 , 15 , 17 , 18 , 21 , 22 , 23 anemia was present in 23 cases (63.63%), 9 , 10 , 25 , 26 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 12 , 39 , 40 , 14 , 15 , 17 , 20 , 22 , 23 , 24 leukocytosis was present in 19 cases (45.45%) 9 , 11 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 13 , 15 , 17 , 18 ,…”

https://jag.journalagent.com/cpr/pdfs/CPR_45_5_524_527.pdf

“…Although oral manifestations are not rare, these are usually gingival enlargement and bleeding, oral ulcers, petechiae, and mucosal pallor. 3 These occurrences are either following direct infiltration of the leukemic cells or secondary to the impaired function of the hematopoietic cells. A recently published review article by Quispe et al 4 concluded that oral cavity can harbor the initial manifestations of leukemia, particularly acute myeloid leukemia (AML).…”

Gingival Enlargement Can Constitute the Only Diagnostic Sign of Leukemia: Report of an Unusual Case

“…Specifically, over 30% of individuals who are diagnosed with leukemia experience various oral manifestations [ 12 ]. The most commonly observed findings include gingival hypertrophy, spontaneous bleeding, petechiae, ulcerations, and oral mucosa pallor [ 11 , 13 ]. The initial indications of leukemia often become apparent in the oral cavity as a result of the invasion of leukemic cells in oral tissues or the reduction of normal bone marrow elements (red cells, white blood cells, and platelets), particularly during the acute stage of the illness [ 14 ].…”