Correct Answer : Leukemia
Explanation :
Gingival infiltration in a patient with fever, fatigue, and weight loss is most suggestive of acute leukemia, especially monocytic variants of acute myelogenous leukemia. This patient’s gingival infiltration resolved after treatment for acute myelomonocytic leukemia.
On physical examination, red, swollen gingivae, tender submandibular lymph nodes, and a palpable spleen were noted. Laboratory evaluation revealed a peripheral-blood white-cell count of 194,100 per cubic millimeter, with 44% blasts, and a peripheral-blood platelet count of 12,000 per cubic millimeter. Examination of a bone marrow–biopsy specimen showed acute myelomonocytic leukemia with dysplastic eosinophils with a deletion of chromosome 16q and trisomy 22, karyotypic abnormalities (variant M4E). Leukemic infiltration of the gingivae has been associated with monocytic variants of acute myelogenous leukemia. After emergency treatment with plasmapheresis 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.
Created by USMLE PlAB MCQ
