Oncohematological diseases often debut with various inflammatory processes localized in different regions, including the maxillofacial region. Myelodysplastic syndrome in a 77-year-old patient with long-lasting hemorrhaging on the skin was recognized only by specialists of the surgical hospital after the onset of osteomyelitis of the mandible. The patient was admitted to the department of maxillofacial surgery with complaints of acute pain and mobility of the teeth in the mandible on the right, the presence of a fistula there, dizziness, nausea and general weakness. The symptoms appeared 10 days before admission. There was asymmetry of the face due to swelling of the tissues on the right. The fistula and tenderness on palpation were also determined there. There was identified pathological mobility of 43-46 teeth of the 4th degree. The mucous membrane of the alveolar process of the mandible was necrotized on the right. Radiography showed rarefaction of bone structures in the root area of teeth 4.4-4.6. The blood test revealed leukopenia, anemia, accelerated ESR; the bone marrow punctate was extremely poor in cellular elements. The type of hematopoiesis was normoblastic with a large number of drop-shaped erythrocytes. The granulocyte lineage was narrowed. The megakaryocytic lineage was represented by single loose platelets. Megakaryocytes in the preparation were negative. The number of blast cells was increased (10.4%). The patient was prescribed a complex antibiotic therapy, including topical. The patient was transferred to the hematology department, where the following diagnosis was made: myelodysplastic syndrome, refractory anemia with excessive blasts. Acute chronic osteomyelitis of the mandible on the right. Against the background of symptomatic therapy, some clinical and laboratory positive dynamics were noted: the number of blast cells decreased to 1%. The patient's condition remained severe due to intoxication, symptoms of heart failure, anemia. On the ninth day of hospital stay, the patient refused the proposed specific therapy, and was discharged for outpatient follow-up care. Doctors of all specialties, especially practitioners specialized in primary medical care, need to maintain high alertness regarding oncohematological diseases in elderly patients and refer them to laboratory tests in a timely manner.
Oncohematological diseases often debut with various inflammatory processes localized in different regions, including the maxillofacial region. Myelodysplastic syndrome in a 77-year-old patient with long-lasting hemorrhaging on the skin was recognized only by specialists of the surgical hospital after the onset of osteomyelitis of the mandible. The patient was admitted to the department of maxillofacial surgery with complaints of acute pain and mobility of the teeth in the mandible on the right, the presence of a fistula there, dizziness, nausea and general weakness. The symptoms appeared 10 days before admission. There was asymmetry of the face due to swelling of the tissues on the right. The fistula and tenderness on palpation were also determined there. There was identified pathological mobility of 43-46 teeth of the 4th degree. The mucous membrane of the alveolar process of the mandible was necrotized on the right. Radiography showed rarefaction of bone structures in the root area of teeth 4.4-4.6. The blood test revealed leukopenia, anemia, accelerated ESR; the bone marrow punctate was extremely poor in cellular elements. The type of hematopoiesis was normoblastic with a large number of drop-shaped erythrocytes. The granulocyte lineage was narrowed. The megakaryocytic lineage was represented by single loose platelets. Megakaryocytes in the preparation were negative. The number of blast cells was increased (10.4%). The patient was prescribed a complex antibiotic therapy, including topical. The patient was transferred to the hematology department, where the following diagnosis was made: myelodysplastic syndrome, refractory anemia with excessive blasts. Acute chronic osteomyelitis of the mandible on the right. Against the background of symptomatic therapy, some clinical and laboratory positive dynamics were noted: the number of blast cells decreased to 1%. The patient's condition remained severe due to intoxication, symptoms of heart failure, anemia. On the ninth day of hospital stay, the patient refused the proposed specific therapy, and was discharged for outpatient follow-up care. Doctors of all specialties, especially practitioners specialized in primary medical care, need to maintain high alertness regarding oncohematological diseases in elderly patients and refer them to laboratory tests in a timely manner.