Temporomandibular Joint Arthritis as an Initial Presentation of Acute Myeloid Leukemia With Myelodysplasia-Related Changes: A Report of an Unusual Case.

Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons

PubMedID: 24661537

Brazelton J, Louis P, Sullivan J, Peker D. Temporomandibular Joint Arthritis as an Initial Presentation of Acute Myeloid Leukemia With Myelodysplasia-Related Changes: A Report of an Unusual Case. J Oral Maxillofac Surg. 2014;.
PURPOSE
Patients with acute myeloid leukemia (AML) often present with fatigue and severe pancytopenia. We report the case of a 68-year-old woman with no significant medical history who presented with 1 year of progressively worsening bilateral temporomandibular joint (TMJ) pain. She was otherwise asymptomatic. A computed tomography scan revealed degenerative joint disease in both TMJs. Bilateral TMJ replacement was performed.

MATERIALS AND METHODS
The excised TMJ tissue underwent formalin fixation and decalcification, and routine hematoxylin and eosin-stained sections were generated.

RESULTS
Immunohistochemical stains showed a population of monotonous cells in the marrow space expressing CD33, CD43, and myeloperoxidase, confirming the diagnosis of myeloid neoplasm. Subsequent bone marrow biopsy with flow cytometry confirmed AML with myelodysplasia-related changes.

CONCLUSIONS
Adult patients with AML can rarely present with musculoskeletal complaints alone, which could delay the diagnosis. To our knowledge, this is the first report of AML with myelodysplasia-related changes presenting in a patient with TMJ degenerative joint disease that was otherwise asymptomatic.