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Oral amoebiasis with acute myeloblastic leukemia
Eiji Mitate1,2, Kazunari Oobu2, Tamotsu Kiyoshima3, Seiji Nakamura2
1Section of Oral Surgery, Department of Oral and Maxillofacial Surgery, Fukuoka Dental College, 2-15-1, Tamura, Sawara-ku, Fukuoka 814-0175, Japan.
2Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan.
3Laboratory of Oral Pathology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan.

Article ID: Z01201607LE10018LM
doi:10.5348/ijcri-201602-LE-10018

Address correspondence to:
Eiji Mitate
D.D.S., PhD, Section of Oral and Maxillofacial Oncology
Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University
3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582
Japan

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How to cite this article
Mitate E, Oobu K, Kiyoshima T, Nakamura S. Oral amoebiasis with acute myeloblastic leukemia. Int J Case Rep Images 2016;7(7):486–487.



To the Editors,

Oral manifestations are frequent seen in immunocompromised patients. In some cases, Entamoeba gingivalis, was isolated and described by Gros G. [1], is found in periodontal disease [2], under chemotherapy [3], HIV(+)/AIDS patients [4] and acute osteomyelitis [5]. To our knowledge, this is the first case report of oral amoebiasis in immunocompromised patients with acute myeloblastic leukemia (AML). A 63-year-old male had painful refractory palatal and lower gingival ulcers (Figure 1A-B). Each ulcer was filled with necrotic tissue and had a 5-mm induration. Some large and enhanced cervical lymph nodes were detected on computed tomography (Figure C) scan. Brush cytological examination revealed oral amoebiasis without malignancy (Figure 1D). Vitamin B12 and folic acid were administrated for anemia. Blood examination revealed the following values: white blood cells 990/µl, red blood cells 1.32x106/µl; and hemoglobin 4.8 g/dl, with higher hemoglobin F level. The patient was referred to the hematology department, where he was diagnosed as having AML (M2) after bone marrow biopsy. Remission induction treatment (idarubicin hydrochloride and cytarabine) was initiated. Aspergillus pneumonia, bacteremia in trichosporonosis, and tuberculous cervical lymphadenitis were also treated. After two months of remission, agranulocytosis and recurring AML were detected. During chemotherapy for AML, the patient died of trichosporonosis-related pneumonia. E. gingivalis is rare in healthy gingival pockets [5]. The presence of E. gingivalis may suggest some immune deficiency. In this case, detection of E. gingivalis by brush cytology and blood examination revealed immune deficiency. If malignancy or immune deficiency is expected, these two methods are considerable in early stage.


Keywords: Acute myeloblastic leukemia, Entamoeba gingivalis, Immunocompromised, Oral amoebiasis


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Figure 1: Oral ulcers are seen in lower gingiva (A) and palate (B) at first visit, (C) Cervical lymph nodes with rim enhance are seen (C, arrowheads) in computed tomography, (D) Brush cytological examination of ulcers showing amoebiasis.


References
  1. Gros G. Fragments d'helminthologie et de physiologie microscopique. Bull Soc Imp Nat Moscou 1849;22: 549–73.    Back to citation no. 1
  2. Linke HA, Gannon JT, Obin JN. Clinical survey of Entamoeba gingivalis by multiple sampling in patients with advanced periodontal disease. Int J Parasitol 1989 Nov;19(7):803–8.   [CrossRef]   [Pubmed]    Back to citation no. 2
  3. el Azzouni MZ, el Badry AM. Frequency of Entamoeba gingivalis among periodontal and patients under chemotherapy. J Egypt Soc Parasitol 1994 Dec;24(3):649–55.   [Pubmed]    Back to citation no. 3
  4. Lucht E, Evengård B, Skott J, Pehrson P, Nord CE. Entamoeba gingivalis in human immunodeficiency virus type 1-infected patients with periodontal disease. Clin Infect Dis 1998 Sep;27(3):471–3.   [CrossRef]   [Pubmed]    Back to citation no. 4
  5. Bhaijee F, Bell D. Entamoeba gingivalis in Acute Osteomyelitis of the Mandible. Case Rep Med 2011;2011:357301.   [CrossRef]   [Pubmed]    Back to citation no. 5

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Author Contributions:
Eiji Mitate – Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Kazunari Oobu – Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Tamotsu Kiyoshima – Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Seiji Nakamura – Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
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Authors declare no conflict of interest.
Copyright
© 2016 Eiji Mitate et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.