Abstract
IntroductionAcute promyelocytic leukaemia, an uncommon and devastating subtype of leukaemia, is highly prevalent in Latin American populations. The disease may be detected by a dentist since oral signs are often the initial manifestation. However, 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. This is the first known case involving these particular features.Case presentationA 24-year-old Latin American man 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. A physical examination later revealed that the patient had pallor, jaw enlargement, ecchymoses and gingival haemorrhage. Laboratory findings showed pancytopaenia, delayed coagulation times, hypoalbuminaemia and elevated lactate dehydrogenase. Splenomegaly was detected on ultrasonography. Peripheral blood and bone marrow analyses 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.ConclusionThe description of this unusual presentation of acute promyelocytic leukaemia, the diagnostic difficulties and the fatal outcome are 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 patient's cytogenetic analysis, clinical course and therapeutic response are well documented.
Highlights
Acute promyelocytic leukaemia, an uncommon and devastating subtype of leukaemia, is highly prevalent in Latin American populations
The description of this unusual presentation of acute promyelocytic leukaemia, the diagnostic difficulties and the fatal outcome are directed toward dental surgery practitioners to emphasise the importance of clinical assessment and preoperative evaluation as a minimal clinicallyoriented routine
Up to 65% of patients with acute leukaemia consult a dentist due to oral manifestations, or the disease is detected from suggestive findings during periodontal and/or physical examination
Summary
Periodontal signs are commonly the first clinical manifestations of AML, including M3-APL This case emphasises the importance of performing a detailed periodontal history and obtaining relevant medical information, adequate interpretation of physical findings and following established protocols. It highlights the relevance of a systematic clinical assessment by dental surgeons by ordering pertinent laboratory tests and making early references to haematologists and/or internists if any suspicions arise from the preoperative assessment. Written informed consent was obtained from the patient's family for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal
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