Abstract
Proptosis in childhood can be a diagnostic dilemma. We present a child who came with subacute onset, bilateral and asymmetric proptosis. He was diagnosed to have pseudotumor on the basis of imaging studies and started on systemic steroids. He responded partially, only to have a recurrence few weeks later. Baseline blood investigations showed a substantial drop in hemoglobin. Peripheral blood smear (PBS) showed atypical cells suggestive of leukemia. A bone marrow biopsy confirmed acute myeloid leukemia. The case illustrates an extra-ocular, systemic cause of proptosis, which was missed on initial presentation. The clue to the diagnosis was clinched on simple baseline tests such as hemoglobin and PBS. An extra-ocular cause, though uncommon, should always be considered in evaluation for every childhood proptosis to prevent delayed diagnosis.
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