Question: A young adult gentleman with no past medical history presents to clinic with 1 week of bleeding gums. He has had 3 weeks of fatigue and decreased appetite with an unintentional 12-pound weight loss. Examination is notable for tender cervical and submandibular lymph nodes as well as the gums seen in the image. What is the most likely diagnosis?

Answer:

His CBC was notable for WBC of 194K with 40% blasts and platelets of 12,000/mL. Bone marrow biopsy showed acute myelomonocytic leukemiaand he was diagnosed with leukemic gingival infiltration.

Leukemic infiltration of the gingivae has been associated with monocytic variants of AML (M4 and M5 subtypes). There are several case reports of AML in the literature presenting as gingival hyperplasia, bleeding, and/or pain. In these case reports, after appropriate treatment of the AML, the gingival pathology improves.

Resource: https://medicine.stanford.edu/residency/shape/image-challenge.html