Forum for Clinical and Surgical Oral Pathology

Case BBOPF 07-2

Dr. Alan Goldberg (private practice, New Jersey, USA) is seeking your comments, differential diagnosis and management for one of his cases. This case will be posted from March 13 to March 20, 2007. A summary of the responses will be posted in BBOP.

Clinical History

In June 2000, a palatal expander was placed in a 14 year old. On July 2001, the patient was diagnosed with Acute Lymphocytic Leukemia with Philadelphia Chromosome. In October 2001, a marrow stem cell transplant was performed. A relapse occurred in February 2002. In October 2002 a blood stem cell transplant was done. The patient was started on Gleevec (400 mg) daily in November, 2002 and stopped it in October, 2003.

In December, 2003 a blood test came back positive for Leukemia. In January, 2004 the patient was restarted on Gleevec (600mg) daily. On October 2004, bands and brackets for full orthodontic treatment were placed. The palatal discoloration shown in the following color images was first noted before the start of orthodontic treatment and did not blanch. The orthodontic treatment was completed on January 2007. Presently, the platelet count is 180,000-225,000.

• What is your differential diagnosis and management for this patient?

Images

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(Click for a larger version)

THIS IS AN ACADEMIC EXERCISE ONLY. THE REPLIES ARE NOT TO BE CONSTRUED AS THOSE OF A CONSULTANT FOR LEGAL PURPOSES.

Case prepared by Dr. Alfredo Aguirre (BBOP Manager) and Daniel Emmer (Web Administrator, University at Buffalo School of Dental Medicine).