Approach to a Child with Bilateral Proptosis as a Rare Presentation of Acute Myeloid Leukemia

Abstract

A 6-year-old girl presented with a 2-month history of sudden onset, painless, progressively increasing bilateral proptosis, palpable lymphadenopathy and skin pallor. A full blood count showed bicytopenia and the erythrocyte sedimentation rate (ESR) was raised. Computerized tomography (CT) scan showed bilateral lacrimal gland enlargement. The bone marrow biopsy was consistent with M2 acute myeloid leukemia (AML). The patient received symptomatic treatment and was sent to pediatric oncologist for induction chemotherapy and tumor lysis syndrome (TLS) protocol. Bilateral proptosis is a rare manifestation of several diseases. This case report emphasizes on the low threshold for hematological malignancies in the presentation of bilateral proptosis. Ophthalmologists should be cognizant of the unusual ophthalmic manifestations of haematological malignancies, as they are a diagnostic challenge but knowledge about the rare extramedullary manifestations of AML facilitates early diagnosis and thereby improves prognosis. Categories: Ophthalmology, Pediatrics, Hematology