Intended for healthcare professionals

Endgames Case Review

Swollen gums in a young adult

BMJ 2023; 380 doi: (Published 08 March 2023) Cite this as: BMJ 2023;380:o2492
  1. Adeline Hillan, medical registrar1,
  2. Michael F Leahy, consultant haematologist12
  1. 1Haematology Department, PathWest Laboratory Medicine, Royal Perth Hospital, Perth, Australia
  2. 2University of Western Australia, Perth, Australia
  1. Correspondence to A Hillan Adeline.hillan{at}

A woman in her 20s presented to the emergency department with a three week history of gingival swelling (fig 1), purulent exudate from the gums, and pain. At a previous dental review in the weeks before presentation the patient had been prescribed two courses of oral antibiotics for presumed gingival infection, but because gingival swelling did not improve a wisdom tooth was subsequently removed. The patient did not have any relevant medical history or concomitant drug use. Computed tomography was performed to exclude periodontal infection. Table 1 shows the results of laboratory tests. Full blood count showed more than 50% immature blasts, …

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