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Periorbital cellulitis as the initial presentation of acute lymphoblastic leukaemia
Charmaine Han-Menz1,2, Sheikh Arif Maqbool Kozgar3,4, Mohammad Sohial Rana2
1Paediatrics, Latrobe Regional Hospital, Traralgon, Victoria, Australia.
Insights
Periorbital cellulitis, initially treated as infection, unexpectedly revealed B-cell acute lymphoblastic leukemia (ALL). This case highlights the importance of considering ALL in ophthalmic presentations mimicking infection.
Area of Science:
- Ophthalmology
- Pediatric Oncology
- Infectious Diseases
Background:
- Periorbital cellulitis is common in children.
- Acute lymphoblastic leukemia (ALL) can rarely present with ocular symptoms.
Purpose of the Study:
- To report a unique case of B-cell ALL initially presenting as periorbital cellulitis.
- To emphasize the differential diagnosis of ophthalmic manifestations in ALL.
Main Methods:
- Clinical case presentation with detailed history and examination.
- Diagnostic imaging (CT scan) and microbiological culture (eye swab).
- Hematological investigations including bone marrow biopsy.
Main Results:
- Initial diagnosis of Staphylococcus aureus periorbital cellulitis progressed to necrotizing fasciitis.
- Incidental finding of pancytopenia led to the diagnosis of B-cell ALL.
- No direct ocular or intraocular leukemic infiltration was found.
Conclusions:
- Periorbital cellulitis can be an initial, albeit rare, presentation of B-cell ALL.
- Ophthalmologists should consider ALL in the differential diagnosis of periorbital inflammation, especially when unresponsive to antibiotics.
- This case underscores the need for a broad differential diagnosis in pediatric ophthalmology.
Abstract:
A girl in early childhood with no significant medical history developed left eye periorbital oedema and erythema. She was treated with intravenous antibiotics for suspected severe periorbital cellulitis. Despite treatment, the patient's cellulitis progressed into necrotising fasciitis, and she was transferred for ophthalmology review and imaging. A CT scan and eye swab culture-confirmed Staphylococcus aureus periorbital cellulitis. Incidentally, pathology revealed significant pancytopenia suspicious of leukaemia. The patient underwent bone marrow biopsy and was diagnosed with B-cell acute lymphoblastic leukaemia (ALL). A multidisciplinary specialist assessment revealed no ocular evidence of leukaemia and no intraocular concerns. In medical literature, it is consistently found that cases of ALL initially manifesting as proptosis or eyelid oedema are invariably due to neoplastic infiltration. This case represents unique documentation where periorbital cellulitis is the initial presentation of B-cell ALL, underscoring the necessity to consider periorbital cellulitis as a possible differential diagnosis in ophthalmic manifestations of ALL.
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