A 12-year-old patient presents with generalized fatigue, bleeding gums, petechiae on the palate, and gingival enlargement. What condition may they have?

Correct answer: B. Leukemia

• A. Aplastic anemia causes pancytopenia with fatigue and bleeding — but the SPECIFIC gingival enlargement points more to leukemic cell infiltration.
• B. This presentation — adolescent + FATIGUE (general illness) + GINGIVAL BLEEDING + PETECHIAE on palate + GINGIVAL ENLARGEMENT — is CLASSIC for LEUKEMIA (particularly acute myelogenous leukemia / AML). Leukemic cell infiltration of the gingiva causes gingival overgrowth. Thrombocytopenia from bone marrow involvement causes petechiae and bleeding. Dental manifestation of leukemia may be the FIRST presenting sign.
• C. Thrombocytopenia (low platelet count) would cause bleeding and petechiae — but not the GINGIVAL ENLARGEMENT seen in this patient. Leukemia is the more complete diagnosis.
• D. Drug-induced gingival overgrowth is associated with cyclosporine, phenytoin, or CCBs (like nifedipine) — not with fatigue and petechiae in a child.