Fatigue and Painful, Swollen Gums

Fatigue and Painful, Swollen Gums

A 48-year-old woman presented to the emergency department with a 1-week history of fatigue and painful, swollen gums. On examination, she was febrile and tachycardic with a well-demarcated region of gingival infiltration and whitening and submandibular lymphadenopathy. A white-cell count was 225,000 per cubic millimeter.

What is the diagnosis?