Emma is a 23-year-old university student who presents with a four-week history of progressive gingival swelling, pain, bleeding and now purulent exudate.

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<p>Emma is a 23-year-old university student who presents with a four-week history of progressive gingival swelling, pain, bleeding and now purulent exudate.</p><p>She initially saw her dentist about this and had been prescribed two courses of oral antibiotics for infective gingivitis, with no improvement.</p><p>Orthopantomogram was reportedly normal.</p><p>Emma usually enjoys good health, takes the oral contraceptive pill, continuously cycled, and uses no over-the-counter or illicit drugs.</p><p>In the past couple of months she has been unusually tired and noticed bruising on her upper and lower limbs, with no recalled injuries.</p><p>On examination she appears pallid, temperature is 37.8°C, heart rate 110 regular, BP 90/62mmHg.</p><p>There are multiple ecchymoses on the limbs and trunk.</p><p>Dental findings are pictured.</p>

Dr Kate Kelso is a GP and medical editor at Australian Doctor.