Mouth ulcer: More than an oral lesion

Abstract

Girl aged 2 years consulting for ulcer in palate
after 4 days of progress. Worsening during the
last 24 hours with an increase of its size, necrotic
aspect and bad smell (Figure 1). Partial ingestion
rejection with a non‐quantified weight loss
during the last month. Presenting with fever for
the last 12 hours, skin paleness and haematomas
in different progress stages.
Blood analysis
Anaemia (Hb 6.6 g/dL), leukopenia (100 total
neutrophils) and trombopenia of 19.000. Blood
smear: 8% of blasts. Lesion culture: Candida
Albicans and klebsiella pneumonia. The diagnosis
of acute leukaemia in bone marrow is confirmed
(Acute Monocytic Leukaemia LMA‐M5B). The
computed tomography shows a mouth affectation
of soft parts without bone lesion. Acute myeloid
leukaemia (AML) represents 15% of childhood
leukemia [1]. Extramedullarymyeloid leukaemia
(EML), also known as sarcoma or chloroma
myeloid is an uncommon, localised tumour
formed by immature granulocytic blood
cells. In the majority of cases there are two
subtypes of AML: Monocytic M5 (25‐30%), and
Myelomonocytic M4 (10‐20%).