By vgreene, 26 April, 2019

INJ

(BMJ)—A 24-yo man was referred due to excessive bleeding during dental scaling. He described 1mo of painless gum swelling but no other sx. Labs: WBC count: 11×109/L, w/ 5% blasts; platelets low, at 70×109/L. What’s the dx?
Methamphetamine abuse
Acute myeloid leukemia
Vitamin C deficiency
Plasma cell gingivitis
Sarcoidosis
You are correct. Bx showed bone marrow w/ 80% antimyeloperoxidase-positive blasts, morphologically consistent w/ myelomonocytic acute myeloid leukemia (AML-M4). Cytogenetic and molecular tests showed no abnormalities. Gingival hypertrophy is a presenting feature in 5% of AML cases. Other etiologies include local inflammation (dental plaque), drugs (phenytoin, amlodipine, cyclosporine), vitamin C deficiency, and infiltrative disorders (sarcoidosis). Perform a full blood count if the hypertrophy doesn’t improve w/ local tx (dental scaling or antiseptic mouthwash), if there’s excessive bleeding, or if constitutional sx are present.

BMJ 2019;364:l708