Chloroma of the orbit as a presenting feature of acute myeloid leukemia in a four year old female child

Dr Tanvi Poy Raiturcar,Dr Aparna Naik,Dr Ugam Usgaonkar

doi:10.17511/jooo.2018.i04.10

Dr Tanvi Poy Raiturcar, Dr Aparna Naik + Show 1 more

Open Access

https://doi.org/10.17511/jooo.2018.i04.10

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Abstract

A four year old female child presented with a painless swelling of the right lower lid for 25days, which was progressively increasing in size. On palpation, a firm nodular mass just above the inferior orbital margin was noted. MRI showed homogenous enhancing mass in the orbit. Progressive axial proptosis developed in 8 days, with inability to close the eye. Bone marrow aspiration at this stage revealed Acute Myeloid Leukemia. Chemotherapy was started. Bone marrow picture after 10days showed remission phase. Symptoms and signs began to regress. The child was discharged on maintenance chemotherapy; but was admitted 3weeks later with fever; the child expired after admission 2 days due to secondary infection.

Highlights

Among the malignancies seen in childhood, myeloid leukemia is very common, and has a prevalence of 1520% [1]
Chloroma is a localized tumor composed of malignant cells of myeloid origin which occurs in patients with Acute myeloid leukemia (AML), and appears as a greenish yellow tumour mass which is seen to involve the bones of the skull, orbit, skin and abdomen [2]
Most commonly chloroma is seen to occur as a manifestation of established myeloid leukemia; but very rarely it precedes the diagnosis of leukemia

Summary

Introduction

Among the malignancies seen in childhood, myeloid leukemia is very common, and has a prevalence of 1520% [1]. Chloroma is a localized tumor composed of malignant cells of myeloid origin which occurs in patients with AML, and appears as a greenish yellow tumour mass which is seen to involve the bones of the skull, orbit, skin and abdomen [2]. Manuscript received: 28th August 2018 Reviewed: 7th September 2018 Author Corrected: 14th September 2018 Accepted for Publication: 19th September 2018 Blood investigations at this stage revealed severe anemia with a haemoglobin of 6.6% and a platelet count of 20,000. Over the 8 days the child developed progressively increasing axial proptosis with associated chemosis, and inability to close the eye. After 3 weeks the child was brought back to the hospital with fever and cytarabine induced neutropenia. The relatives took the child home against medical adviceand within 3 days we received the information of her death

Discussion

Conclusion