Intra‐oral noma‐like lesion associated with acute myeloid leukaemia: a case report

Abstract

Acute myeloid leukaemia is a malignancy of the white blood cells that can develop in both children and adults with rapid development and possible intra‐oral manifestations. This report describes a case involving a 50‐year‐old patient who was referred to the Emergency Department of a University Dental Hospital complaining of severe intra‐oral ulceration, spontaneous intra‐oral bleeding and generalised fatigue and malaise. Examination revealed the existence of an erythematous intra‐oral necrotising, noma‐like, ulceration in the posterior area of the right buccal mucosa. The patient was diagnosed with acute myeloid leukaemia. Acute myeloid leukaemia develops rapidly and the initial symptoms may be non‐specific. Patients may demonstrate intra‐oral manifestations; most common symptoms include spontaneous gingival bleeding, gingival enlargement and acute ulceration. Ulceration with necrotising (noma‐like) characteristics is a rare oral manifestation of acute myeloid leukaemia, the cause of which is yet unknown. Fewer than 10 cases have been reported in the international literature. Intra‐oral pathology can be an early indicator of significant medical pathology. A dental practitioner is likely to be the first point of contact for patients with acute myeloid leukaemia due to the unusual or painful nature of the intra‐oral pathology; identification of suspicious signs and symptoms can lead to early detection and treatment. Clinical relevance Leukaemia may present initially to dental practitioners because of a high incidence of early intra‐oral signs and symptoms. A high index of suspicion for underlying systemic disease will lead to prompt onward referral for specialist investigations. Oral presentations may include spontaneous gingival bleeding and gingival enlargement. A rare oral presentation of acute myeloid leukaemia is deep and severe oral ulceration presenting as a noma‐like lesion, which we present here.

Oral manifestations of leukemia as part of early diagnosis

“…A total of 33 individuals were identified in the selected studies: 19 males (57.57%) 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 and 14 females (42.42%). 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 The age ranged from 6 to 74 years and only 6 individuals (18.18%) were between 1.6 and 12 years old.…”

“… 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 The age ranged from 6 to 74 years and only 6 individuals (18.18%) were between 1.6 and 12 years old. 10 , 19 , 22 , 26 , 31 , 32 …”

“…Among the types of leukemia, oral manifestations were present principally in acute myeloid leukemia (24 individuals [72.72%]), 9 , 12 , 14 , 15 , 16 , 17 , 18 , 19 , 22 , 23 , 24 , 25 , 30 , 32 followed by acute lymphoid leukemia (6 individuals [18.18%]), 10 , 13 , 20 , 21 , 26 , 31 adult T-cell leukemia/lymphoma (2 individuals [6.06%]) and chronic lymphoid leukemia (1 individual [3.03%]).…”

“…The oral MOLs were in gingival tissue (63.63%), 9 , 12 , 17 , 18 , 19 , 21 , 23 , 24 , 25 , 26 , 27 , 30 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 15 , 40 alveolar and jugal mucosa (18.18%) 14 , 18 , 21 , 22 , 26 , 28 and hard or soft palate (18.18%). 9 , 11 , 15 , 16 , 27 , 30 Other regions, such as the floor of the mouth (12.12%), 13 , 16 , 23 , 38 tongue (9.09%), 13 , 33 , 39 lip (3.03%), 13 parotid glands (3.03%), 10 and nasolabial region (3.03%), 26 were less frequent.…”

“…The general signs and symptoms, in addition to the oral manifestations, were mainly the following: weakness, fatigue, lethargy or tiredness in 11 individuals (45.45%); 9 , 12 , 15 , 17 , 18 , 20 , 23 , 26 , 30 , 36 lymphadenopathies in 8 individuals (36.36%); 9 , 14 , 15 , 17 , 22 , 25 , 26 , 27 mucosal pallor in 6 individuals (27.27%); 12 , 14 , 15 , 22 , 26 weight loss in 4 individuals (18.18%) 15 , 17 , 23 , 38 and loss of appetite in 5 individuals (18.18%). 9 , 16 , 23 , 26 , 32 Adjacent areas, such as the head and neck regions, presented submandibular lymphadenopathy, 9 , 10 , 15 , 26 , 34 cervical lymphadenopathy, 17 , 27 , 34 dysphagia, 9 , 16 , 17 facial asymmetry 10 , 26 , 31 , 37 and trismus.…”