Acute Myelogenous Leukemia Presenting with Primary Oral Lesions Initially Diagnosed as Acute Necrotizing Ulcerative Gingivitis

We report two cases that presented to the emergency department (ED) with oral pain, fever, and malaise, with physical findings leading to the initial diagnosis of acute necrotizing ulcerative gingivitis (ANUG), also known as Vincent’s angina and trench mouth. Both cases on repeat exam, not only failed to improve, but required immediate admission. Both worsened rapidly despite appropriate antibiotic therapy, and both succumbed to their illness within a few days. In both cases, the underlying diagnosis was acute myelogenous leukemia (AML) in blast crisis. It is likely that the leukemic infiltrates seen in monocytic variants of AML contributed to the gingival morphology which lead to the misdiagnosis of ANUG.