Rapidly progressing, fatal acute promyelocyticleukaemia that initially manifested as a painful third molar: a case report
IntroductionAcute promyelocytic leukaemia is an uncommon and devastating subtype of leukaemia, with a high prevalence in Latin American populations. The disease may be detected by a dentist since oral signs are often the initial manifestation.
Despite several cases describing oral manifestations of acute promyelocytic leukaemia and genetic analysis, reports of acute promyelocytic leukaemia in Hispanic populations are scarce. The identification of third molar pain as an initial clinical manifestation is also uncommon.
To our knowledge, this is the first case report including these particular features.Case presentationA 24-year-old Latin American male without relevant antecedents consulted a dentist for pain in his third molar. After two dental extractions, the patient experienced increased pain, poor healing, jaw enlargement and bleeding.
Later, a physical exam revealed a patient with pallor, jaw enlargement, ecchymoses and gingival haemorrhage. Laboratory findings showed pancytopaenia, delayed coagulation times, hypoalbuminaemia and elevated lactate dehydrogenase.
Splenomegaly was detected ultrasonographically. Peripheral blood and bone marrow analysis revealed a hypercellular infiltrate of atypical promyelocytic cells.
Cytogenetic analysis showing genetic translocation t(15;17), further confirmed acute promyelocytic leukaemia. Despite early chemotherapy, the patient died within one week due to intracranial bleeding secondary to disseminated intravascular coagulation.
Conclusion: The description of this unusual presentation of acute promyelocytic leukaemia and the diagnostic difficulties and fatal outcome is particularly directed toward dental surgery practitioners to emphasise the importance of clinical assessment and preoperative evaluation as a minimal clinically-oriented routine.
This case may also be of particular interest to haematologists, since the cytogenetic analysis, clinical course and therapeutic response are reasonably well documented.
Author: Juan Suarez-CuencaJose Arellano-SanchezAldo Scherling-OcampoGerardo Sanchez-HernandezDavid Perez-GuevaraJuan Chalapud-Revelo
Credits/Source: Journal of Medical Case Reports 2009, 3:102
Published on: 2009-11-03
Copyright by the authors listed above - made available via BioMedCentral (Open Access). Please
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