First manifestation of an acute myleoid leukaemia on the lower lip with fulminant course

Acute myleoid leukaemia is a malignancy of haematopoetic cells with proliferation of malignant leucocytes and destruction of the bone marrow. Besides general and unspecific symptoms also petechiae or haemorrhages of the oral mucosa or gingival hyperplasia can be an indication for acute myleoid leukaemia.

We report the case of a 71 year old male with a rare first manifestation of an acute myleoid leukaemia on the lower lip and fulminant course. Initially recurrent haemorrhage from an ulcer on the lower lip occurred. After unsuccessful conservative treatment and suspicion of actinic keratosis we performed an outpatient excision in local anesthesia and covering the defect with an advanced flap from the buccal cavity. Few hours later our patient developed a high-fever infection with dyspnea, anemia and haemodynamic instability so an intensice care treatment was necessary. Due to pneumonia, very large nonspecific macroglossia and tetraparesis a respirator therapy was required for four weeks. The histological examination showed an acute myleoid leukaemia (NPM1-mutation type A, FLT 3-ITD positive). Under chemotherapy with cytarabin, mitoxantrone and etoposide a intermediate remission was achieved. Since recurrence occurred after tree months several cycles of Azacitidine and Sorafenib were given after which remission was achieved again.

This case demonstrates that a timely evaluation of small, supposedly harmless ulcers of the lips is important, because these may present a first manifestation of fulminant diseases like acute myleoid leukaemia.

Publication History

Publication Date:
18 April 2018 (online)