Rapidly progressive acute periodontal infection in a patient with acute leukemia

The clinical course of an adult patient with acute lymphocytic leukemia and localized, rapidly progressive periodontal disease in a setting of marrow regeneration is described. Initial presentation of this condition was consistent with herpes simplex virus infection involving the gingiva; however, more extensive evaluation including radiographs, cultures and biopsy revealed necrotic tissue, nonspecific bacterial growth and acute gingival inflammation, with no evidence of viral infection. While most acute oral infections in chemotherapy patients occur during the development of marrow aplasia, this lesion initially developed late during the marrow recovery phase. The characteristics of this lesion are compared with those occurring in noncancer patients with rapidly progressive periodontitis and who have genetically governed neutrophil and/or lymphocyte defects.