DR. ALISHA KULKARNI

PROF.DR. VIJAYA PAI H

Abstract

A 6-year-old female child presented with protrusion of both eyes since 15 days. History of on and off fever, headache, vomiting, neck pain since 1 month. Patient was on treatment for tuberculous meningitis. She also had right side facial palsy which recovered gradually. On examination, she had bilateral proptosis. Anterior segment evaluation was normal with no RAPD. Visual acuity was (RE) 6/9p and (LE) 6/6. Fundus showed papilloedema. MRI orbits showed (RE) 3 X 1.5cm and (LE) 3.1×1.2cm isointense lesion in the extraconal compartment with intracranial extension on both sides. A probable diagnosis of bilateral proptosis due to leukemia/lymphoma was made. Haematological investigations showed anaemia, low RBC count, thrombocytopenia and elevated LDH and uric acid. Bone marrow study showed abnormal lymphoid cells and flow cytometry was positive for CD19, CD79a, CD20, sKAPPA, sLAMBDA and HLA-DR. A diagnosis of Burkitt’s lymphoma was made and was started on chemotherapy.