<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_jccm-2020-0031_s_005_w2aab3b7c10b1b6b1aab1c15b1Aa"><h3>Introduction</h3><p>In acute myeloblastic leukaemia (AML) explosive proliferation and accumulation of immature myeloid cell clones take place, replacing the bone marrow, with the possibility of the formation of extramedullary tumour masses composed of myeloid cells. The onset of the disease less frequently consists of symptoms of extramedullary manifestation.</p></sec><sec id="j_jccm-2020-0031_s_006_w2aab3b7c10b1b6b1aab1c15b2Aa"><h3>Case presentation</h3><p>A Caucasian male child aged three years and 11 months was hospitalized for bilateral exophthalmos and otorrhea, due to an alteration in his general condition. Ocular ultrasound revealed an inhomogeneous thickening of the upper right muscles superior to the eyeball. A complete blood count showed severe anaemia, leucocytosis with neutropenia and thrombocytopenia. A peripheral blood smear evidenced myeloblasts. The result of the cytology of bone marrow confirmed the diagnosis of AML. Following blood product replacements and cytostatic treatment (AML-BFM 2004 HR protocol), the remission of exophthalmos and the correction of haematological parameters were favourable.</p></sec><sec id="j_jccm-2020-0031_s_007_w2aab3b7c10b1b6b1aab1c15b3Aa"><h3>Conclusion</h3><p>In a child with a sudden onset of exophthalmia and altered general condition, the diagnosis of acute leukaemia should be considered. The importance of performing a peripheral blood smear and bone marrow examination is emphasized so that diagnosis and initiation of treatment are not delayed.</p></sec></abstract>

IntroductionIn acute myeloblastic leukaemia (AML) explosive proliferation and accumulation of immature myeloid cell clones take place, replacing the bone marrow, with the possibility of the formation of extramedullary tumour masses composed of myeloid cells. The onset of the disease less frequently consists of symptoms of extramedullary manifestation.Case presentationA Caucasian male child aged three years and 11 months was hospitalized for bilateral exophthalmos and otorrhea, due to an alteration in his general condition. Ocular ultrasound revealed an inhomogeneous thickening of the upper right muscles superior to the eyeball. A complete blood count showed severe anaemia, leucocytosis with neutropenia and thrombocytopenia. A peripheral blood smear evidenced myeloblasts. The result of the cytology of bone marrow confirmed the diagnosis of AML. Following blood product replacements and cytostatic treatment (AML-BFM 2004 HR protocol), the remission of exophthalmos and the correction of haematological parameters were favourable.ConclusionIn a child with a sudden onset of exophthalmia and altered general condition, the diagnosis of acute leukaemia should be considered. The importance of performing a peripheral blood smear and bone marrow examination is emphasized so that diagnosis and initiation of treatment are not delayed.

Bilateral Ocular Exophthalmia – A Case of Atypical Acute Myeloblastic Leukemia in a Child

The Journal of Critical Care Medicine

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

IntroductionIn acute myeloblastic leukaemia (AML) explosive proliferation and accumulation of immature myeloid cell clones take place, replacing the bone...

Drug name	Strength	Dosage	Route of administration	Dates of administration
human immune globulin	2,5g/25ml	1 fl/day	intravenously	Day 13
(CSL Behring GmbH, Marburg, Germany)

red blood cell		10ml/kg	intravenously	Day 9,21

pooled platelets		1unit/10kg	intravenously	Day 7-16, 21-25

trimethoprim-sulfamethoxazole	(40mg/200mg)/5ml	2x10ml/day	orally	Day 24-26
(E.I.P.I.Co., Tenth of Ramadan City, Egypt)

fluconazole	2mg/ml	100 mg once	intravenously	Day 17-27
(Fareva Amboise, Pocé-Sur-Cisse, France)		daily

granisetron	1mg/ml	1mg twice a	Intravenously	Day 4-11
(Fresenius Kabi Austria GmbH, Graz, Austria)		day

Bilateral Ocular Exophthalmia – A Case of Atypical Acute Myeloblastic Leukemia in a Child

Article Category: Case Report

Published Online: Nov 07, 2020

Page range: 243 - 248

Received: May 15, 2020

Accepted: Aug 29, 2020

DOI: https://doi.org/10.2478/jccm-2020-0031

Keywords
bilateral ocular exophthalmos, atypical onset, acute myeloblastic leukaemia, myeloid sarcoma

© 2020 Réka Toth, Alina Grama, Cristina Maki, Mihaela Ioana Chinceșan, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1

Fig. 2

Fig. 3

Routine tests results performed on Day 1 post-admission to Paediatrics Clinic

Bone marrow immunophenotyping

Supportive care of the induction phase.

Bilateral Ocular Exophthalmia – A Case of Atypical Acute Myeloblastic Leukemia in a Child

Article Category: Case Report

Published Online: Nov 07, 2020

Page range: 243 - 248

Received: May 15, 2020

Accepted: Aug 29, 2020

DOI: https://doi.org/10.2478/jccm-2020-0031

Keywordsbilateral ocular exophthalmos, atypical onset, acute myeloblastic leukaemia, myeloid sarcoma

© 2020 Réka Toth, Alina Grama, Cristina Maki, Mihaela Ioana Chinceșan, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1

Fig. 2

Fig. 3

Routine tests results performed on Day 1 post-admission to Paediatrics Clinic

Bone marrow immunophenotyping

Supportive care of the induction phase.

Keywords
bilateral ocular exophthalmos, atypical onset, acute myeloblastic leukaemia, myeloid sarcoma