An undiagnosed case of acute myeloid leukemia
A 43-year-old female patient reported to the Department of Periodontology, with the chief complaint of generalized bleeding gums, and gingival swelling from last 2 months. Patient gave no history of fever, malaise, weight loss in the recent past. Patient was not under any medication for chronic illness. Extra oral examination reveals bilateral submandibular and deep cervical lymphadenopathy; lymph nodes were indurated and tender on palpation. Systemic examination reveals mild hepatomegaly and splenomegaly.\nIntraoral examination revealed generalized enlargement of the maxillary and mandibular gingiva involving the buccal, lingual, and palatal aspects [Figure –]. The gingiva was swollen, inflamed, erythematous, and devoid of stippling. On palpation gingiva was firm and edematous, tender and bleeding on slight provocation. There was a fair amount of plaque and calculus, but did not justify the amount of enlargement. Orthopantomogram did not reveal any significant findings.\nThe following differential diagnoses were considered: Inflammatory enlargement, conditioned enlargement, systemic enlargement, and neoplastic enlargement.\nComplete blood count [] revealed marked increase in white blood cells, decrease in red blood cells with decrease in hemoglobin levels, and low platelets count; indicative of leukocytosis, anemia, and thrombocytopenia.\nPeripheral smear depicted numerous blast cells, mainly immature leukocytes with few erythrocytes and thrombocytes [].\nThese results confirmed the final diagnosis of acute myeloid leukemia. Oral hygiene instruction was given to the patient. Patient was instructed to use soft bristle toothbrush, as gingiva was inflamed, friable and edematous use of hard or regular brush is not recommended. Thrice a day Chlorhexidine (0.2%) was prescribed as oral rinse.[] Scaling and root planning was postponed since the treatment needs a minimum platelet count of 60 000 in this condition. Patient was immediately referred to the oncology centre for further management, where bone marrow biopsy confirms acute myeloid leukemia M5 and chemotherapy started. Patient did not respond well to chemotherapy and succumbed to the disease within 10 days of admission.