標題 Oral manifestations as an early clinical sign of acute myeloid leukaemia: a case report
原文題目(出處)： Australian Dental Journal 2015; 60: 123–127 原文作者姓名： G Guan,* N Firth*
通訊作者學校： Department of Oral Diagnostic and Surgical Sciences, School of Dentistry, The University of Otago, Dunedin, New Zealand
報告者姓名(組
別)： 楊鎧銘(intern L 組)
報告日期： 104/7/7 內文：
Abstract：
1. Leukaemia is the most common malignancy in children and one of the most common malignancies in young adults. Acute myeloid leukaemia is often associated with early oral manifestations.
2. The purpose of this study is to report the case of a 49-year-old male with spontaneous gingival bleeding for over two years with undiagnosed leukaemia.
3. Since oral lesions can be one of the early events of acute myeloid leukaemia, they may be considered as an important diagnostic indicator for oral health practitioners, and their roles in diagnosing and treating such patients.
Introduction：
1. Oral manifestations are often potential indicators of systemic diseases, so recognizing them can lead the way to a prompt diagnosis and management.
2. Leukaemia is a malignancy of haematopoietic cells characterized by the proliferation of malignant leucocytes and destruction of the bone marrow.
3. General manifestation of leukaemia may include fatigue, anaemia, lymphadenopathy, recurrent infection, bone and abdominal pain, bleeding and purpura.
4. Oral manifestations of leukaemia may include petechial haemorrhages of the tongue, lips, posterior hard and soft palate, gingival hyperplasia and spontaneous gingival bleeding, and ulcerations
5. Patient may also suffer from severe viral, bacterial and fungal infections as a
Case report:
1. In September 2013, a 49-year-old male was referred and wanted to evaluate and
treatment of persistent bleeding gingivae palatal to his maxillary central incisors that the patient had first noticed two years previously. He had not been concerned until the previous evening when the bleeding would not stop.
2. He had a history of exertional breathlessness, which had worsened over several weeks.
The gingivae were painless and showed no abnormal swelling during this period.
3. Past medical history:
(1) No history of facial trauma.
(2) He had chronic muscular skeletal back and neck pain, congenital glaucoma with bilateral goniotomies and right buphthalmos.
(3) He was taking clindamycin due to tonsillitis.
(4) Allergic to penicillin.
(5) No family history of any bleeding disorders 4. No smoke and rarely drank alcohol.
5. Extraoral examination:
(1) No regional lymphadenopathy or salivary gland swelling (2) The patient appeared very fatigued, weak and pale.
(3) Spoon-shaped fingernails (koilonychia) were noted.(fig.1)
6. Intraoral examination:
(1) It revealed buccal mucosal pallor(fig.2) and severe gingival haemorrhagearound without any touching or probing at the tooth 11 and 21 palatal gingival margin.
(2) Tooth 11 and 21 were positive to sensibility testing.
(3) Periodontal pocket depths were less than 3 mm.
(4) No dental plaque or calculus deposits were detected clinically.
7. X-ray finding:
Panoramic and periapical radiographs showed no abnormal dental or osseous finding.
8. Lab test:
9. Treatment:
(1) Tranexamic acid 5% mouthwash to arrest the bleeding.
(2) Received standard dose daunorubicin/cytarabine induction chemotherapy.
(3) Had been given consolidation therapy with a more intensive chemotherapy regimen known as FLAG/ Idarubicin.
(4) As his AML was unlikely to be cured with chemotherapy alone, an allogeneic stem cell transplant was planned.
Discussion:
1. AML is an aggressive myeloid neoplasm that results from clonal transformation of haematopoietic precursors through the acquisition of chromosomal rearrangements and multiple gene mutations.
2. AML is a relatively uncommon disease, accounting for approximately 25% of all leukaemias in adults in the western world.
3. AML is an aggressive disease that predominantly occurs in older adults, with a median age at diagnosis of over 65 years. AML is rarely diagnosed before the age of 40 years 4. The incidence of AML varies with gender and ethnicity.
5. Clinical presentation
(1) Most of these clinical signs and symptoms are related to the reduction of leucocytes and erythrocytes
(2) Splenomegaly, hepatomegaly and lymphadenopathy.
(3) Neutropenia, thrombocytopenia and anaemia.
(4) Fever, fatigue, pallor, bleeding and purpura, bone and abdominal pain and recurrent infections.
6. Oral manifestations (1) Mucosal pallor
(2) Spontaneous bleeding and petechial haemorrhages of gingivae, palate, tongue or lip
(3) Gingival hyperplasia.
(4) Laryngeal pain and oral ulcerations
(5) Patients may also have severe recurrent viral, bacterial and fungal oral infection, such as diffused chronic mucocutaneous candidiasis, recurrent herpetic
gingivostomatitis and bacterial infection
(6) Pre-existing periodontal disease can exaggerate the leukaemic infiltration and worsen the gingival enlargement.
7. Relative disease
conclusion：
Oral lesions are one of the initial manifestations of acute myeloid leukaemia. This case emphasizes that oral health practitioners should be familiar with the systemic manifestations and oral complications of blood diseases and leukaemia.
1 Which of the following disease is the risk factor associated with AML?
(A) Down syndrome (B) Lichen planus (C) Myxoma
(D) Bechet’s disease
答 (A) 出處：oral and maxillofacial pathology, third edition, P587
2 Which of the following is not the clinical feature of leukemia?
(A) Oral ulceration (B) Gingiva bleeding
