Could this be leukemia?

[SKH17]

I've had a dry, non-productive cough, low-grade temp., and chills for about five weeks now. I've also been feeling extremely tired and physically fatigued, and for the past two weeks or so my knees, ankles, and jaw (I have TMJ, but it's been especially bad lately) have been in a lot of pain. When I saw my doctor a week and a half ago she told me that the lymph nodes on the back of my neck were swollen and she thought that I probably had mono, but blood drawn later that day ruled it out. I finished five days of azithromycin almost a week ago and haven't gotten any better. I also have scattered petechiae on my hands, wrists, arms, and legs that haven't faded at all since I noticed them weeks ago. My WBC was 8.7 with a reference range of 4.0-10.0 and my RBC was 3.8 with a reference range of 3.9-5.2. My neutrophils were 72.3% with a ref. range of 34.0-71.1 and neutrophil number was also flagged as high as 6.3 with a range of 1.6-6.1.  I read online that neutrophils can be elevated by stress but I was not stressed or nervous or anything like that when I had my blood drawn. Also, I take Zyrtec everyday year round for allergies so I don't know if that means that my WBC would really have been higher if I hadn't taken it that day.

[Hien K Duong, MD]

SKH17,

Your symptoms sound more likely related to an infectious process, possibly viral, and therefore antiobiotics may not be helpful.  Although the likelihood that this is leukemia or lymphoma is low, you should follow up with your doctor closely and have your blood tests repeated, especially if you continue to have persistent symptoms.  If your cough persists, A chest x-ray may also be helpful. If your lymph nodes remain swollen or get larger in size, it will also be important to obtain a biopsy.  

Other worrisome symptoms can include persistent fevers, frequent and persistent nightsweats, significant weight loss, and worsening fatigue.

Elevated neutrophil count can occur in the setting of inflammation or infection. Your WBC is normal and your neutrophil count is only slightly elevated – at some hospitals, your WBC count would still fall within a normal range.  Your WBC count is not concerning or suggestive of leukemia.  Typically in leukemia, the neutrophil count is significantly decreased, if not absent.  

Regarding the petechiae, this is more often related to a low platelet count or blood clotting factor deficiencies.   If they are truly petechiae, they should be investigated further and you should bring them to the attention of your physician.

Your WBC count is not affected by the Zyrtec and you can certainly continue to take that as you need to for your allergies.

[Hien K Duong, MD]

Kylie1115,

Acute leukemia can rarely present as gingival hypertrophy, however it is usually accompanied by other symptoms as well.  Given the history that you describe, it is not likely leukemia. Your bruising and possible petechiae seem to have resolved.  It may take a few more days for your gum swelling to improve.  

If gum swelling continues, you may want initial evaluation from dentist.  They may be able to direct you as to whether further evaluation from a physician would be necessary.

Thanks for your question and good luck.

[Kylie1115]

I don't have many of the symptoms mentioned by SKH,, There is no fatigue. No swelling or joint pain. No swollen lymph nodes, etc. However, I did notice a few unexplained bruises last week (which are gone now), and what may have been a few, like 5 or 6 spots of petechiae (which is gone now) and have no more recur. A sore throat that only lasted a few days, and gums which have been swollen for about a week. Normally I wouldn't worry, but the fact that my gums are still swollen has me slightly concerned. Should I go see a doctor rather than a dentist?