• Vanja Vučićević Boras, Danica Vidović Juras, Igor Aurer, Sandra Bašić-Kinda, and Mirta Mikulić.
• 1Department of Oral Medicine, School of Dental Medicine, University of Zagreb; 2Department of Oral Diseases, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Hematology, School of Medicine and Zagreb University Hospital Centre, Zagreb, Croatia; 4Croatian Bone Marrow Donor Registry, Zagreb University Hospital Centre, Zagreb, Croatia.
• Acta Clin Croat. 2019 Sep 1; 58 (3): 556-560.

AbstractA 40-year-old female patient was admitted to the Department of Oral Medicine due to oral ulcerations. Oral ulcerations were present on vestibular mucosa above teeth 21, 22, 25 and 26 and were 1 cm in diameter, and also around teeth 45 and 46. The patient had prolonged neutropenia due to therapy-related myelodysplastic syndrome that progressed to therapy-related acute myeloid leukemia. Initially, the patient was successfully treated with polychemotherapy for non-Hodgkin lymphoma. Unfortunately, many toxic complications ensued, such as peripheral neuropathy, dilated cardiomyopathy and therapy-related myelodysplastic syndrome/therapy-related acute myeloid leukemia. The onset of therapy-related myelodysplastic syndrome was less than six months after initiation of chemotherapy treatment, which was rather early, but cytogenetic changes (monosomy 5 and 7) were consistent with the diagnosis. Upon admission to our Department, microbiological swabs were obtained and were all negative, while x-ray finding showed that ulcerations did not have dental cause. Biopsy was not obtained as the patient had severe neutropenia and thrombocytopenia. While viral and fungal swabs were negative, Stenotrophomonas maltophilia was cultured from the oral cavity. Thus, differential diagnoses are listed in this report. Neutropenic ulcerations did not heal albeit extensive medicamentous oral and systemic treatments were applied and the patient died.

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