|Year : 1971 | Volume
| Issue : 3 | Page : 143-144
Bilateral proptosis with acute myeloid leukaemia
SH Hafeez Ahmad, RK Mishra, S Agarwal
Department of Ophthalmology and Pathology, Medical College, Jabalpur, M.P, India
S H Hafeez Ahmad
Department of Ophthalmology and Pathology, Medical College, Jabalpur, M.P
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Hafeez Ahmad S H, Mishra R K, Agarwal S. Bilateral proptosis with acute myeloid leukaemia. Indian J Ophthalmol 1971;19:143-4
|How to cite this URL:|
Hafeez Ahmad S H, Mishra R K, Agarwal S. Bilateral proptosis with acute myeloid leukaemia. Indian J Ophthalmol [serial online] 1971 [cited 2019 Dec 5];19:143-4. Available from: http://www.ijo.in/text.asp?1971/19/3/143/34975
Bilateral proptosis is fairly common in association with acute and chronic lymphatic leukaemia, and it has been observed to occur in 2 percent cases by Reese and Guy  on the other hand myelogenous leukaemia rarely gives rise to proptosis (Wright  and Duke Elder  Wright  reported a case of proptosis with myeloid leukaemia associated with fever in a 4 years old Indian child. Chatterji and Sent observed proptosis in the right eye only in a case of acute myeloid leukaemia. Wright  further stated that the common cause of proptosis in leukaemia cases was spontaneous orbital heamorrhage. The following is the report of a case of acute myeloid leukaemia with an early presenting symptom of bilateral proptosis.
| Case Report|| |
A Hindu male child aged 11 years attended the ophthalmic department of Medical College Hospital, Jabalpur, M.P. on 3-2-1970 with a history of swelling of both upper lids and prominence of eye balls since a week. History of fever off and on since last 15 days.
Vision right eye 6/24 and left eye 6/9. Reaction of the pupils direct and indirect were normal. The upper lids were full and tense, showing no adhesions underneath. A hard mass was felt within the supra-orbital margins. The mass was fixed, irregular and no tenderness was noticed. Both eye balls were pushed forwards and slightly downwards with restricted movements all round. [Figure - 1].
Media were clear in both eyes. Bilateral papilloedema (3D) and retinal oedema were present, but no heamorrhages or exudates were seen.
There was no enlargement of liver, spleen or lymph nodes. The air sinuses were normal. The boy were normal.
Haemoglobin 8 gm. %. Total leucocytes 20,000 per cent. There was anisocytosis. Platelets were reduced in number.
Peripheral blood film showed, blast cells 58%, myelocyte 2%, Stales cells 8 % polymorph 11%, lymphocyte 20%, monocyte 1%,).
Peroxidase staining showed positive results (Presence of granules in the immature cells).
Bone marrow biopsy showed M.E. ratio to be 10: 1 with predominant myeloblasts.
Liver biopsy did not show leukaemia infiltration or any other specific change.
Blood cholesterol - 115 mgm. E.S.R. 55 mm at the end of 1st hour. BMR (+14). Urine examination: no abnormality was detected. X'ray of the skull and orbit did not show any positive findings.
| Discussion|| |
Acute myeloid leukaemia may manifest with diffuse infiltration in various organs or rarely in localized deposits of leukaemic cells. This case came to us with bilateral moderate proptosis, without any other local or general symptoms.
Therefore investigations like blood cholesterol, B.M.R. and X'ray of the orbit were done to find out the cause of proptosis. They did not reveal any positive findings. The peripheral blood film and the bone marrow examinations clinched the diagnosis of acute myeloid leukaemia. With a view to diagnosing such cases correctly and in time Cromble  suggests that in all cases of orbital proptosis, even if peripheral blood count and film are not greatly abnormal, a bone marrow biopsy should be performed.
Duc and Wright  have observed that Myelogenus leukaemia does not give rise to proptosis except as a great rarity. Usually the cause of proptosis in these cases is spontaneous orbital heamorrhage. Reese and Guy  also reported a case of Myelogenous leukaemia in which choroidal heamorrhage was the cause of acute proptosis.
Osterwald and Schiotz  reported papilloedema as a rare complication in such cases. Chatterji and sen  observed a normal fundus in their case of acute myeloid leukaemia with proptosis. Leukaemia is usually accompanied by the widespread systematic implication of the lymph nodes, spleen, liver etc., but in this case the proptosis was not associated with any wide spread leukaemic inrlltration.
| Summary|| |
Acute myeloid leukaemia with bilateral proptosis (no orbital haemorrhage) and without systematic implication and with unusual complications (papilloedema and retinal oedema) is reported. The diagnosis is established by pathological examinations.
| References|| |
CHATTERJI and SEN: Acute Myeloid Leukemia - Leukemic deposit in Orbit. British. J. Ophthal. 44, 441: (1960).
CROMBIE - J. All Indian Ophthal Soc., Acute Bilateral proptosis. 16, 90, 1968. (Quoted by Sen, H. Mohan and Gupta).
DUKE - ELDER S. (1952): 'Text Book of Ophthalmology'. Vol. 5, M. 5551 and 5552. Henry Kimpton, London.
HAMEED S., DAS T. and AGARWAL K. C.: Chloroma of the Orbit, Brit. J. Ophthal. 43, 107: (1959).
MORTADA: Amer. J. Ophthal. Orbital Lymphoblastomas and Acute Leukemias in children. Vol. 35 - 1963, page 327.
REESE A. B. and GUY. L. (1933): Exophthalmos in Leukemia Amer. J. Ophthal. 16, 718.
SORSBY, A.: 'Systemic Ophthal.', p. 574, Butter worth, London. (1951)
WRIGHT (1938) `Extra-ecular affection' Madras (Quoted by Duke elder 1952).
[Figure - 1]