Oral Manifestations of Acute Myelomonocytic Leukemia: A Case Report and Review of the Classification of Leukemias

Wu, Josephine W.; Fantasia, John E; Kaplan, Robert

doi:10.1902/jop.2002.73.6.664

Cited by 53 publications

(37 citation statements)

References 20 publications

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“…The resulting decrease of functional white blood cells, red blood cells and platelets is responsible for immunodeficiency, anaemia, and thrombocytopenia, respectively. [1][2][3][4] The leukaemias are subdivided into chronic and acute forms. Chronic leukaemias involve relatively well-differentiated leukocytes, presenting a slow onset and run an indolent course.…”

Section: Introductionmentioning

confidence: 99%

Severe necrotizing stomatitis and osteomyelitis after chemotherapy for acute leukaemia

Santos

Pochapski

Pilatti

et al. 2009

Australian Dental Journal

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Background: Leukaemia is a malignant neoplasm characterized by clonal proliferation of white blood cells within the bone marrow. Despite an increase in the white blood cell count, the leukaemic leukocytes are non-functional. The oral complications arising in leukaemic patients can be attributed to the direct and indirect effects of immunosuppressive chemotherapy. Methods: This case report describes severe maxillary and mandibular necrotizing stomatitis and osteomyelitis in a young female patient after chemotherapy for acute leukaemia. On physical examination, the patient presented malnourished with pale skin, cervical lymphadenitis, frequent fever and generalized pain. The intra-oral clinical examination found halitosis, multiple ulcers, necrotizing stomatitis and osteomyelitis located in the maxillary and mandibular regions. The necrotizing stomatitis and osteomyelitis were treated locally with atraumatic removal of the necrotized tissues. The patient received a daily preventive protocol consisting of oral hygiene care, including twice daily brushing, and mouthrinses with a solution of chlorhexidine. She was also treated with systemic metronidazole and amoxicillin for 21 days. Results: During the course of management the patient's oral condition improved with some re-epithelialization being noted. However, severe alveolar bone destruction remained evident. Thirty-two months after presentation of the initial symptoms, the patient died due to complications related to leukaemia recurrence (haemorrhage, sepsis and respiratory distress syndrome). Conclusions: Dental monitoring during cancer treatment is imperative in order to emphasize the importance of dental plaque control and the maintenance of a healthy periodontal condition throughout medical treatment.

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Section: Introductionmentioning

confidence: 99%

Severe necrotizing stomatitis and osteomyelitis after chemotherapy for acute leukaemia

Santos

Pochapski

Pilatti

et al. 2009

Australian Dental Journal

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“…[13][14][15][16][17][18][20][21][22] While there is no consensus in the literature about the most prevalent oral manifestations in leukemic patients, gingival bleeding, gingival swelling, ulcers and petechiae are the most frequently reported. 1,4,5,[8][9][10][11][12]16,17,19 In patients undergoing active treatment for leukemia, gingival bleeding and petechiae were the most common findings in the oral cavity, occurring twice as often in patients having the acute form of leukemia. 13 Hou et al, 18 in a retrospective study of patients at diagnosis, found that gingival bleeding was the second earliest sign of disease.…”

Section: Discussionmentioning

confidence: 99%

“…In this sense, thrombocytopenia is considered an important secondary effect of the disease and a potential risk factor. [3][4][5] Oral manifestations (gingival swelling [7][8][9][10][11][12] and gingival and oral bleeding [13][14][15][16][17][18] ) have been associated with leukemia. Gingival swelling is the most common oral sign in untreated patients.…”

Section: Introductionmentioning

confidence: 99%

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Gingival inflammation and platelet count in patients with leukemia: preliminary results

et al. 2011

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Leukemia has been associated with oral manifestations. However, the available literature on this topic consists of mostly reports of cases, without data about the periodontal parameters that may be under the influence of hematologic factors. The aim of this cross-sectional study was to assess the correlation between the Gingival Index and Bleeding on Probing with the platelet count in patients with leukemia. Patients with diagnosis of any kind of leukemia, at any stage of treatment, having a minimum age of 14 years, treated at the Department of Hematology-Oncology of the University Hospital of Santa Maria, Brazil, between December 2009 and March 2010, were assessed. Excluded patients were: edentulous, with orthodontic appliances, with psychomotor disturbances, requiring antibiotic prophylaxis for the examinations, or those using medications associated with gingival swelling. Two trained and calibrated examiners evaluated the Plaque Index, Gingival Index (GI), Probing depth, Bleeding on Probing (BOP), and Clinical Attachment Loss. Hematologic data were collected from a blood test performed on the same day as the periodontal examination. Thirty-seven patients (26 males), aged between 15 and 80 years (mean age 41.7 ± 18.31) were evaluated. Correlation between platelet count and BOP (p > 0.05), or between platelet count and GI (p > 0.05), were both weak (Pearson's correlation coefficient r = 0.171 and r = −0.003, respectively) and not statistically significant. It can be concluded from the preliminary results that the low platelet count was not correlated with the higher prevalence of gingival and periodontal bleeding in patients with leukemia.

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“…L'âge médian de survenue est de 64 ans [7], elle est plus fréquemment observée chez l'homme que chez la femme [5]. La chimiothérapie antimitotique [10], la radiothérapie externe [15] ou l'exposition au benzène [3] représentent des facteurs de risques qui peuvent orienter la démarche diagnostique. Le taux de survie est très variable (de 20 à 60 %) : il dépend du caryotype et de la possibilité de trouver un donneur HLA compatible pour effectuer une allogreffe.…”

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Leucémie aiguë myéloïde : le tableau clinique est parfois trompeur

Lafon

Belangeon

Ahossi

et al. 2010

Med Buccale Chir Buccale

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Mots clés : leucémie aiguë myéloïde / hyperplasie gingivale / hémogramme / myélogrammeRésumé -Les auteurs se proposent, à partir de deux observations cliniques, de montrer qu'une LAM (leucémie aiguë myéloïde) peut, d'un côté, se présenter de manière classique avec confirmation biologique d'emblée et, de l'autre, se traduire par des manifestations cliniques, masquées par un contexte particulier où il est difficile de suspecter une LAM en première intention. L'intérêt de cette communication est de montrer qu'à partir de signes cliniques très différents tant dans l'exubérance que dans la discrétion, le diagnostic reste le même alors que l'issue est totalement opposée. Il ressort de cette expérience que toute expression buccale d'une pathologie générale doit être systémati-quement bilantée dès sa prise en charge initiale.Key words: acute myeloid leukaemia / gingival hyperplasia / complete blood count / bone marrow biopsy Abstract -Acute myeloid leukaemia: when clinical presentation represents a trap. The authors try to present through two clinical observations that a AML (acute myeloid leukaemia) can, in one hand, be recognized rapidly and induce a biological confirmation and, in the other hand, that the clinical manifestations could be concealed by a particular general context where the AML couldn't be diagnosed in the first intention. The first case describes a 39 year-old woman addressed to University hospital dental medicine clinic from Dijon by her physician for generalized gingival hyperplasia. The history shows a normal blood numeration two months before. The results of the complete blood count and bone marrow biopsy reveal a AML associated with intravascular coagulation. The second case presents a 39 year-old woman with a good health. The history shows a few recent specialized consultations: three times in gynaecology, two times in generalized medicine, once by the dentist and at the dental medicine clinic from Dijon. All these consultations didn't show any particularity except a gingivitis caused by her pregnancy. The patient went to the emergency for extreme oral pain, which were treated by morphine injection. She was then reoriented to the dental medical faculty. The patient is immediately hospitalised for complete blood analyses. The brutal aggravation of the general being of the patient associated with signs of neurological pain, leads us to realize in emergency a brain-tomograph. The result was a cerebral hemorrhagic which was followed in only a few hours by the death of the patient. The results of the biological examination show the existence of an AML. The aim of this paper is to present two cases with different clinical symptoms where the diagnosis is the same but the prognostic is strictly opposed. In conclusion, all patients with oral manifestation of their general disease must receive systematically a precise biological examination.La leucémie est définie comme étant une prolifération monoclonale maligne de cellules hématopoïétiques de la lignée blanche. Cette prolifération atteint soit la lignée...

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Oral Manifestations of Acute Myelomonocytic Leukemia: A Case Report and Review of the Classification of Leukemias

Abstract: Oral health care professionals, especially periodontists, must recognize that gingival enlargement may represent an initial manifestation of an underlying systemic disease. Acute myelogenous leukemia is a hematological disorder with a predilection for gingival involvement.

Cited by 53 publications

References 20 publications

Severe necrotizing stomatitis and osteomyelitis after chemotherapy for acute leukaemia

Severe necrotizing stomatitis and osteomyelitis after chemotherapy for acute leukaemia

Gingival inflammation and platelet count in patients with leukemia: preliminary results

Leucémie aiguë myéloïde : le tableau clinique est parfois trompeur

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