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CASE REPORT
Year : 1990  |  Volume : 38  |  Issue : 1  |  Page : 38

Proptosis as a manifestation of acute myeloid leukaemia-A case report


Department of Pediatrics and Ophthalmology, Medical College and Hospital, Rohtak- 124 001, India

Correspondence Address:
Sanjiv Nanda
16/IIJ (Old), Medical Enclave, Rohtak - 124 001
India
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Source of Support: None, Conflict of Interest: None


PMID: 2365439

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  Abstract 

A case of unilateral proptosis in a patient of acute myelocytic leukaemia is being reported for its rarity.


How to cite this article:
Nanda S, Chugh J, Tewari A D. Proptosis as a manifestation of acute myeloid leukaemia-A case report. Indian J Ophthalmol 1990;38:38

How to cite this URL:
Nanda S, Chugh J, Tewari A D. Proptosis as a manifestation of acute myeloid leukaemia-A case report. Indian J Ophthalmol [serial online] 1990 [cited 2020 May 30];38:38. Available from: http://www.ijo.in/text.asp?1990/38/1/38/24546


  Introduction Top


Orbital infiltration with bilateral proptosis has been ob­served in 2 percent cases of acute or chronic lympho­tic leukaemia [1],[2].In contrast myelogenous leukaemia only very rarely gives rise to a similar orbital infiltration [2]. We report an unusual case of acute myelocytic leuka­emia with unilateral proptosis as its manifestation.


  Case report Top


A 5 year old male child was admitted with a 7 month history of progressive pallor. There was no history of bleeding from any site. He was transfused blood twice during this period by private practitioners. For the last 2 weeks the patient was having protrusion of the left eye ball with swelling of the eyelids. There were no symp­toms pertaining to raised intracranial tension. He was moderately anaemic with no bleeding spots anywhere over the body. There was no significant lymphadenopa­thy, splenomegaly or hepatomegaly. Ophthalmological examination revealed non-reducible axial proptosis of the left eye with subconjunctival haemorrhage and marked chemosis [Figure - 1]. Ocular movements were restricted in all the directions of gaze. Both direct and indirect pupil­lary reactions were positive in both eyes. The fundus was also found to be normal.

Blood examination revealed Hb 4 gm/dl and TLC 35800/ cumm. Of the total cells polymorphs constituted only 14%, lymphocytes 27%, monocytes 4%, myeloblasts 45%, myelocytes 5% and promyelocytes 5%. Platelet count was 40,000/cumm.

Bone marrow aspirate revealed marked depression of erythropoiesis and megakaryocytopoiesis. M:E ratio increased to 20:1. With the extreme maturation arrest there was proliferation of myeloid cells, predominantly myeloblasts (70%). X-ray of the skull and orbit did not show any positive finding.


  Discussion Top


In the paediatric age group the more common causes of exophthalmos are orbital cellulitis and thyroid embry­opathy [3]. The clinical profile and the haematological pic­ture proved that the present case was a rare instance of acute myelocytic leukaemia (AML) with orbital deposits. Duke-Elder [2] had however observed that AML rarely produces proptosis. The usual cause of proptosis in our patient could be spontaneous retrobulbar haemorrhage into the infiltrated tumor cells. Possibilities of metastatic neuroblastoma and rhabdomyosarcoma were readily excluded. Its differentiation from chloroma (also called granulocytic sarcoma) of orbit also needs to be stressed. In this entity the prominent feature is the deposition of greenish, yellow tumor like localised masses in the skeleton especially the skull. Proptosis which is often bi­lateral is consequent to orbital bone involvement and is usually the presenting feature. Subseqently tumor cells metastasize in the blood to produce acute myelocytic leukaemia. Whatever the nature and colour of deposits the incidence of chloroma is fast declining. To conclude, in all cases of orbital proptosis, even if the peripheral blood count and film are not greatly abnormal, examination of the bone marrow aspirate is mandatory. Only in this way can an early leukaemia in the aleuka­emic phase be diagnosed.

 
  References Top

1.
Reese AB. Guy L. Exophthalmos in leukaemia. Amer J Ophthal 16: 718-720, 1933.  Back to cited text no. 1
    
2.
Duke Elder S. Orbital involvement in leukaemia. In: System of Ophthalmology. Henry Kimpton, London, Vol-X111, pp. 1073-1076, 1974.  Back to cited text no. 2
    
3.
Nichlson DH, Green WR. Tumors of the eye lid and orbit in children. In: Harley RD (Ed) Pediatric Ophthalmology 2nd ed. WB Saunders, Philadelphia Ch. 30 pp. 1123-1271,1983.  Back to cited text no. 3
    


    Figures

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