Swollen gums in a young adult

A woman in her 20s presented to the emergency department with a three week history of gingival swelling (fig 1), purulent exudate from the gums, and pain. At a previous dental review in the weeks before presentation the patient had been prescribed two courses of oral antibiotics for presumed gingival infection, but because gingival swelling did not improve a wisdom tooth was subsequently removed. The patient did not have any relevant medical history or concomitant drug use. Computed tomography was performed to exclude periodontal infection. Table 1 shows the results of laboratory tests. Full blood count showed more than 50% immature blasts, …