BackgroundT-cell large granular lymphocytic (T-LGL) leukemia is a rare, chronic, often
indolent lymphoproliferative disorder of mature T cells (CD3+). Severe
neutropenia and other cytopenias are common features in patients with T-LGL
leukemia and may cause infections, thus representing a major cause of
morbidity in this disease. Immunosuppressive therapy with low-dose regimes
of methotrexate, cyclophosphamide, corticosteroids or cyclosporine A is the
treatment of choice. Amongst the variety of T-LGL leukemia complications,
oral manifestations such as ulcers have been rarely reported. The purpose of
this paper is to report a case of T-cell large granular lymphocyte leukemia
with oral manifestations and to discuss their pathogenesis and
management.MethodsIn the present case, a 65 year old female with a two-month history of
diagnosed T-LGL leukemia presented with oral lesions, including ulcerations
on the ventral tongue and soft palate as well as swollen, erythematous and
ulcerated gingiva. The patient was under treatment with methotrexate,
granulocyte colony-stimulating factor (G-CSF) and erythropoietin.ResultsConsidering patients' medical history and clinical appearance of the lesions,
a clinical diagnosis of a neutropenic ulcer of the tongue was established.
The oral lesions resolved after treatment with antibiotics, topical steroids
and antiseptics combined with improvement of the hematological condition.
The pertinent literature related to T-LGL leukemia ethiopathology,
diagnostics and treatment was discussed.ConclusionsAlthough rare, T-cell large granular lymphocytic leukemia should be included
in the list of lymphoproliferative disorders, which may present with oral
manifestations as a result of the disease and its treatment
complications.
A palatal swelling in a child or adolescent may represent a neoplasm, such as a schwannoma and requires careful clinical and radiographic evaluation of the dentition.
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