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Periorbital cellulitis as the initial presentation of acute lymphoblastic leukaemia
  1. Charmaine Han-Menz1,2,
  2. Sheikh Arif Maqbool Kozgar1,3 and
  3. Mohammad Sohial Rana2
  1. 1 Paediatrics, Latrobe Regional Hospital, Traralgon, Victoria, Australia
  2. 2 Central Gippsland Health Service, Sale, Victoria, Australia
  3. 3 Monash University School of Rural Health, Traralgon, Victoria, Australia
  1. Correspondence to Dr Sheikh Arif Maqbool Kozgar; sheikharif.kozgar{at}


A girl in early childhood with no significant medical history developed left eye periorbital oedema and erythema. She was treated with intravenous antibiotics for suspected severe periorbital cellulitis. Despite treatment, the patient’s cellulitis progressed into necrotising fasciitis, and she was transferred for ophthalmology review and imaging. A CT scan and eye swab culture-confirmed Staphylococcus aureus periorbital cellulitis. Incidentally, pathology revealed significant pancytopenia suspicious of leukaemia. The patient underwent bone marrow biopsy and was diagnosed with B-cell acute lymphoblastic leukaemia (ALL). A multidisciplinary specialist assessment revealed no ocular evidence of leukaemia and no intraocular concerns. In medical literature, it is consistently found that cases of ALL initially manifesting as proptosis or eyelid oedema are invariably due to neoplastic infiltration. This case represents unique documentation where periorbital cellulitis is the initial presentation of B-cell ALL, underscoring the necessity to consider periorbital cellulitis as a possible differential diagnosis in ophthalmic manifestations of ALL.

  • Paediatric oncology
  • Ophthalmology
  • Paediatrics

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  • Contributors CH-M and SAMK were responsible for drafting the text, sourcing and editing clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content. All authors gave final approval of the manuscript.

  • 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.