Acute myeloid leukaemia presenting as proptosis in an infant

Area of Science:

• Paediatric Oncology
• Radiology
• Haematology

Background:

• Acute myeloid leukaemia (AML) in children often causes symptoms due to impaired blood cell production.
• Periosteal reactions are common in paediatric leukaemia, usually appearing as thin, laminated patterns on long bones.
• Aggressive periosteal reactions are rare in this population.

Observation:

• A paediatric patient presented with proptosis and periorbital swelling.
• Imaging revealed aggressive, sunburst periosteal reactions involving the sphenoid and zygomatic bones.
• This presentation differed from the usual thin, laminated periosteal reactions seen in leukaemia.

Findings:

• The aggressive periosteal reactions were caused by leukaemic infiltration.
• This represents an unusual manifestation of paediatric AML.
• The sphenoid and zygomatic bones were affected, leading to facial swelling and proptosis.

Implications:

• This case underscores the importance of including leukaemic infiltration in the differential diagnosis for sunburst periosteal reactions in children.
• Recognizing this rare presentation can lead to earlier diagnosis and treatment of paediatric AML.
• Highlights the diverse radiological manifestations of leukaemia in paediatric patients.