Bilateral Eye Proptosis and Right Temporal Orbital Region Swelling as First Presentation in Acute Myeloid Leukemia

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Nik Nurfarhana Nik Mohd Noor

Abstract

Background: To describe a case of acute myeloid leukaemia (AML) presented with bilateral eye proptosis and swelling over the right temporal orbital region as first presentation.


 


Method: Case report.


 


Result: A 16-year-old Malay boy presented with bilateral eye proptosis and painless, progressive right temporal orbital region swelling for one month. It was associated with difficulty in passing urine and altered bowel habit. Three days prior to presentation he had lower back pain and numbness over bilateral lower limb which progressed to paraplegia two days after admission. On examination, the vision was 6/6 bilaterally with absence of relative afferent pupillary defect. There was axial proptosis in both eyes with restriction of extraocular movement in all gaze. Full blood picture showed bicytopenia with presence of 78% blast cells. Computed tomography of brain and orbit revealed hyperdense lesion at bilateral extraconal spaces and soft tissue swelling at right temporal orbital region. Magnetic resonance imaging of thoracolumbar has no significant findings. Bone marrow aspiration and trephine consistent with AML type M2/M4. He received radiotherapy and planned for chemotherapy but succumbed to his disease.


 


Conclusion: A child or young adult who presented with proptosis and rapidly growing orbital mass, high index of suspicion should be made against acute leukaemia as one of the differential diagnosis.


 


Conflict of interest: None.

Article Details

Section
Case Report

References

1. Saif A, Kazmi SFA, Naseem R, Shah H, Butt MO. Acute Myeloid Leukemia: Is That All There Is? Cureus. 2018; 10(8): e3198. doi: 10.7759/cureus.3198.
2. Ansari S, Rauniyar RK, Dhungel K, Sah PL, Ahmad K, Gupta MK, et al. Acute myeloid leukemia presenting as bilateral proptosis and right temporal swelling. Oman J Ophthalmol. 2014; 7(1): 35–37. doi: 10.4103/0974-620X.127927.
3. Murthy R, Vemuganti GK, Honavar SG, Naik M, Reddy V. Extramedullary leukemia in children presenting with proptosis. J Hematol Oncol. 2009; 2(1): 4. doi: 10.1186/1756-8722-2-4.
4. Zimmerman LE, Font RL. Ophthalmologic manifestations of granulocytic sarcoma (Myeloid sarcoma or chloroma). Am J Ophthalmol. 1975; 80(6): 975–990. doi: 10.1016/0002-9394(75)90326-8.
5. Almalki AMJ, Alotaibi FA, Jabr HF, Mastan AR. Unilateral proptosis as an initial sign of acute myeloid leukemia in a child: A case report. Int Med Case Rep J. 2019; 12: 319–323. doi: 10.2147/IMCRJ.S206596.
6. Bakst RL, Tallman MS, Douer D, Yahalom J. How I treat extramedullary acute myeloid leukemia. Blood. 2011; 118(14): 3785–3793. doi: 10.1182/blood-2011-04-347229.
7. De Kouchkovsky I, Abdul-Hay M. Acute myeloid leukemia: A comprehensive review and 2016 update. Blood Cancer J. 2016; 6(7): e441. doi: 10.1038/bcj.2016.50
8. Koshy J, John MJ, Thomas S, Kaur G, Batra N, Xavier WJ. Ophthalmic manifestations of acute and chronic leukemias presenting to a tertiary care center in India. Indian J Ophthalmol. 2015; 63(8): 659–664. doi: 10.4103/0301-4738.169789.
9. Hanapi MS, Ghani SI, Sonny Teo KS, Wan-Embong WZ, Ariffin N, Wan Hitam WH. Extensive Forehead Swelling Including the Periorbital Area in a Child: A Rare Manifestation of Acute Lymphoblastic Leukemia. Cureus. 2018; 10(11): e3539. doi: 10.7759/cureus.3539.
10. Xiao RZ, Long ZJ, Xiong MJ, Wang WW, Lin DJ. Diagnosis and treatment of a patient with isolated spinal granulocytic sarcoma: A case report. Oncol Lett. 2013; 5(4): 1229–1232. doi: 10.3892/ol.2013.1203.