SHM Converge Scientific Abstract ePoster Gallery-Oral Ulcers Were the Tip of the Iceberg: An Unusual Presentation of Acute Myeloid Leukemia

Pdf Summary

This case report describes a 56-year-old man with type II diabetes who presented with three weeks of painful oral ulcers involving the buccal mucosa, palate, and tongue, along with odynophagia, poor oral intake, fever, and major weight loss. He had already failed outpatient treatment with amoxicillin, fluconazole, and nystatin. On arrival, his initial blood counts were not suggestive of leukemia, which made the diagnosis difficult at first.<br /><br />He was treated for suspected oral infection with incision and drainage, antibiotics, and further workup. Oral tissue culture showed only normal flora, biopsy demonstrated nonspecific inflammation, and serologic tests for viral, syphilitic, and autoimmune causes were negative. Although his oral symptoms improved somewhat, he later developed recurrent fevers and progressive pancytopenia. MRI of the jaw showed osteomyelitis and also an incidental finding of bone marrow reconversion at the skull base, suggesting increased hematopoietic activity and possible bone marrow dysfunction. Because of worsening cytopenias and concern for immunosuppression, a bone marrow biopsy was performed.<br /><br />The biopsy revealed 25% blasts in a hypocellular marrow, confirming acute myeloid leukemia (AML). The authors emphasize that AML can present atypically, including with oral ulcers, and may be missed when initial laboratory studies are normal. In this patient, the oral ulcers were likely the first visible sign of an underlying malignant hematologic process. The case highlights the importance of considering hematologic malignancy in patients with persistent oral lesions, systemic symptoms, or unexplained progression to pancytopenia, even when early tests appear reassuring.

Asset Subtitle

Minh Tu Tran

Meta Tag

Author List Minh Tu Tran, Sami Tahhan, Zahra Tasneem

Category Clinical Vignettes

Concept Acute Myeloid Leukemia

Concept Oral Ulcer

Concept Cytopenia

Concept Pancytopenia

Concept Bone Marrow Reconversion

Distinguished Non-Finalist

Presenter Organization Eastern Virginia Medical School

Presenting Author Minh Tu Tran

Track Adult

Keywords

acute myeloid leukemia

oral ulcers

pancytopenia

bone marrow biopsy

type II diabetes

odynophagia

oral infection

hypocellular marrow

bone marrow reconversion

hematologic malignancy

Acute Myeloid Leukemia

Oral Ulcer

Cytopenia

Pancytopenia

Bone Marrow Reconversion