A case of acute leukemia that presented with sore throat and dysphagia

Acute leukemia is a hematopoietic disease, associated with progressive bone marrow failure. Many acute leukemia patients are well known to experience oral-pharyngeal symptoms, presenting ENT doctors with the opportunity to examine them. Herein, we report the case of a patient who initially visited our ENT department complaining of sore throat and difficulty in swallowing and was eventually diagnosed as having acute leukemia. The patient was a 24-year old man who presented to us with a 4-day history of throat pain. We confirmed pharyngeal pain and an inability to swallow. The patient had fever and swelling of the right peritonsillar region, but no throat congestion. We also detected laryngeal edema and ecchymoses in the upper pharynx. Based on his clinical condition and results of automated blood examination, we initially assumed typical upper respiratory tract inflammation. We treated the patient with antibiotics and steroids, which led to improvement of his condition. However, three days after his hospitalization, we rechecked his blood cell counts by manual techniques and diagnosed acute promyelocytic leukemia. We concluded that disseminated intravascular coagulation (DIC) had caused the ecchymotic patches in the upper pharynx, and that the unilateral peritonsillar swelling had been caused by an opportunistic bacterial infection associated with the decreased white blood cell count. Due to the possibility of potentially uncontrollable bleeding caused by DIC, we elected a non-surgical approach to treatment. In cases presenting with atypical swelling of the tonsils, we recommend a thorough and systematic approach to the diagnosis, including careful consideration of the blood test results, in order to avoid unnecessary surgical treatments.