Differential diagnosis, investigations, and treatment
The panoramic radiograph imaging findings conducted on Oct 12, 2021, showed significant alveolar bone resorption in the upper and lower jaws, and the alveolar hard line, mandibular canal wall, and trabecular structure were indistinct (Figs 3A). Blood test results showed that the white blood cell count was increased to 15900/μl, and other blood cell counts were decreased. In addition, blasts were observed in the peripheral blood, and C-reactive protein, lactate dehydrogenase, and ferritin levels were elevated, suggesting leukemia. A bone marrow examination was then performed to confirm the diagnosis.
Bone marrow biopsy: a diagnosis of B-ALL was made for this patient, with 75.8% of the lymphoblasts being medium to large in size and showing high nucleus/cytoplasm ratio vacuoles. The oral lesions were then attributed to the clinical diagnosis: alveolar bone resorption due to leukemic cell infiltration in B-ALL (Fig 4).