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Acute onset facial oedema: an unusual presentation of acute lymphoblastic leukaemia in a child
  1. Darren Anderson,
  2. Atisha Pandya and
  3. Chhaya Patankar
  1. Paediatrics, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, UK
  1. Correspondence to Dr Darren Anderson; darren.anderson10{at}


A previously fit and well girl of middle-childhood age presented to her local emergency department after waking with upper-facial swelling. She had a 24-hour preceding history of mild vomiting illness and fatigue. Examination revealed palpable splenomegaly and mild cervical lymphadenopathy, with pitting oedema of the forehead, nasal bridge and eyelids. Admission full blood count showed anaemia and neutropenia, and further investigations confirmed a diagnosis of acute lymphoblastic B-cell leukaemia. X-ray of the chest and CT imaging did not reveal any local facial mass, veno-occlusive disease or mediastinal pathology to explain her facial swelling. She was referred to the tertiary paediatric oncology service for commencement of induction chemotherapy.

  • Paediatric oncology
  • Malignant and Benign haematology

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  • Contributors CP identified the case as one of interest for publication. DA and AP performed the review of patient notes and wrote up the case report. DA reviewed the literature on facial swelling and wrote the discussion on this. AP researched and wrote the discussion on acute lymphoblastic leukaemia background information. DA, AP and CP jointly edited the case report and figures to meet submission criteria. CP and AP approached the patient’s parent for permission and obtained informed consent for publication. DA approached the patient’s parent for their written ‘patient’s perspectives’ section. All three authors approve the final edit of this work being submitted and all three authors take responsibility for all aspects of the work. All three authors have confidence on the integrity of their coauthor’s contributions.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.