A 60-year-old woman was referred for evaluation of diffusely hemorrhagic and erythematous lesions of the maxillary and mandibular attached gingiva. The patient had no known allergies, was not a tobacco user, and denied alcohol use. Her medical history was significant for suppurative otitis media, obstructive sleep apnea, hypertension, coronary artery disease, and recurrent pulmonary emboli. Her daily medications included apixaban. Her family history was significant for a first-degree relative (mother) with polycythemia vera.