The n e w e ng l a n d j o u r na l of m e dic i n e

images in clinical medicine

Leukemic Gingival Infiltration

A B

A 
Aparna Mani, M.S. n otherwise healthy 36-year-old man presented with a 6-day
David A. Lee, M.D. ICMhistory
AUTHORof bleeding
Mani gums andRETAKEabdominal 1st pain in the left upper quadrant. He
REG F FIGURE a&b 2nd
Georgetown University Medical Center CASE
reported having had fevers, fatigue, decreased 3rd appetite, and unintentional
TITLE
Washington, DC 20007 weight loss
EMail of 10 lb (4.5 kg)
Line
during
4-C
the previous
Revised month. On physical examination,
am2@georgetown.edu red, swollen
Enon gingivae
ARTIST: mst (Panel
H/T A), tender
H/T submandibular
SIZE lymph nodes, and a palpable
39p6
spleenFILLwere noted. Laboratory Combo evaluation revealed a peripheral-blood white-cell
count of 194,100 per cubic
AUTHOR, PLEASEmillimeter,
NOTE: with 44% blasts, and a peripheral-blood
Figure has been redrawn and type has been reset.
platelet count of 12,000 percarefully.
Please check cubic millimeter. Examination of a bone marrow–biopsy
specimen showed acute myelomonocytic leukemia with dysplastic eosinophils with
JOB: 35803
a deletion of chromosome 16qISSUE: 1-17-07 22, karyotypic abnormalities (variant
and trisomy
M4E). Leukemic infiltration of the gingivae has been associated with monocytic
variants of acute myelogenous leukemia. After emergency treatment with plasma-
pheresis and induction chemotherapy with cytarabine and doxorubicin, the gingival
infiltration resolved (Panel B; image obtained 3 weeks after that in Panel A). The
patient subsequently completed three cycles of consolidation chemotherapy and
remains in remission 1 year later.
Copyright © 2008 Massachusetts Medical Society.

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274 n engl j med 358;3  www.nejm.org  january 17, 2008

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