Bilateral Extra Ocular Muscle Involvement with Proptosis as the Ophthalmic Manifestation and Primary Presentation of Acute Leukemia in an Adult

Abstract

An observational case report of a 32 year Asian seen in Rashid hospital emergency. He presented with bilateral proptosis and bloody eye discharge of two weeks duration. Fever, headache and general weakness of one week duration. There was no prior history of leukaemia or any systemic illness. Clinical examination revealed asymmetrical axial proptosis with restricted extra ocular movements. Diffuse subconjuctival haemorrhage with bloody eye discharge, Figure 1. Anterior segment and fundus examination was unremarkable. A complete blood counts, flow cytometry studies and computerized tomography (CT) were done. ResultsComplete blood counts and differential counts are shown in Table 1. Flow cytometry showed, 77% of the cells were blasts. The blasts were positive for cytoplasmic CD3 (85%), CD7 (95%), CD 10 (82%), CD2 (35%) and CD38.The blasts were double negative for CD8 and CD4 with a sub clone (almost 12 % of the cells ) showing expression of CD8. The blasts also showed aberrant expression of CD13 (98%).The blasts were negative for surface CD3, CD5, CD34 and TDT. They were also negative for myeloid markers CD117, cytoplasmic MPO and CD33. The blasts were negative for HLA DR, CD20, CD22, CD19, CD79a, and for both CD16 and CD56. These results were consistent with the

New Understanding of Ophthalmology Disease Process

“…One month after the second steroid pulse therapy, ocular motility was improved and the inflammation in both inferior rectus muscles had almost resolved. This case illustrates the detailed clinical course of edematous extraocular myopathy in a pediatric Graves' orbitopathy patient, followed-up by successive MRI [59]. Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical entity characterized by a unique pattern of vasogenic brain edema mainly caused by eclampsia, immune suppressing drugs, or severe hypertension.…”