Unilateral periorbital swelling as initial rare presentation of pediatric leukemia

Abstract

Background: Acute lymphoblastic leukemia (ALL) is considered the most typical type of cancer in children, representing around 26% of childhood cancer. Case Presentation: A 13-month-old girl was presented to our clinic who developed unilateral periorbital swelling as her initial sole symptom of ALL. In this report, we described this case with a summary of previously reported cases. The patient previously medically free, was presented with left periorbital swelling and inferior globe displacement, progressing over the preceding 3 weeks. At the initial presentation, slit lamp examination revealed a normal anterior segment with characteristic leukemic retinopathic changes in both eyes with no detected hepatosplenomegaly or enlarged lymph nodes. On investigation, a peripheral smear and bone marrow biopsy showed 80% blast cells. A CT scan showed varying degrees of bilateral extraocular/ocular muscle infiltration. ALL was diagnosed, and the patient immediately underwent induction chemotherapy. Conclusion: This case highlights the importance of understanding and considering rare, aggressive diseases potentially masquerading as simple periorbital edema.