Oral and pharyngeal lesions, such as mucosal or gingival swelling, redness, bleeding and ulcers, are among the initial manifestations of acute leukemia. Herein, we report the case of a patient with bilateral tonsillar hypertrophy as the first and only manifestation of acute leukemia.
A 69-year-old woman presented to our department with bilateral enlarged tonsils. Her general condition was good and there was no fever or pharyngeal pain. Ear, nose, throat and head and neck examination, including examination of the oral cavity, revealed no abnormalities, except for bilateral Grade III tonsillar hypertrophy. However, blood tests revealed marked elevation of the white blood cell count to 45830/μL, with 56% peripheral blastoid cells, and a serum ferritin level of 474.4 ng/dL. A diagnosis of acute leukemia was suspected. She was therefore referred to a hematologist who performed a bone marrow biopsy and confirmed the diagnosis of acute myeloid leukemia. She received remission induction therapy, and the bilateral tonsillar hypertrophy reduced immediately after the start of this treatment.
Based on this experience, we recommend prompt blood testing for patients, especially adults, with enlarged tonsils, regardless of whether they present with unilateral or bilateral swelling, to identify hematological malignancies early, even in the absence of other symptoms such as fever, generalized malaise and bleeding tendency.
