Bilateral Exophthalmos Revealing Acute Myeloid Leukemia in an Infant: Case Report

Acute myeloid leukemia (AML) is a malignancy characterized by the uncontrolled proliferation of immature hematopoietic cells, leading to the infiltration of various tissues. Ocular involvement in AML is rare and typically associated with a poor prognosis. A 1-year-old infant with no significant medical history presented with rapidly progressive bilateral proptosis, more pronounced on the left side, over a 15-day period. Ophthalmological examination revealed painful, inflammatory proptosis and stage 2 bilateral papilledema. CT scans indicated diffuse infiltration of the orbital and extraconical spaces, along with proptosis. Blood tests showed pancytopenia, and a myelogram confirmed the diagnosis of AML. Unfortunately, the child's condition deteriorated due to severe sepsis, leading to death following hospitalization in the pediatric ICU. Ocular involvement in acute leukemia is uncommon but may present as chloroma or granulocytic sarcoma, typically manifesting as rapidly progressive unilateral or bilateral exophthalmos. This can be mistaken for conditions such as rhabdomyosarcoma or infection. The presence of leukemia in the oculo-orbital region is a poor prognostic indicator, as it is considered a central nervous system disorder and should be managed accordingly. The prevalence of ocular involvement has significantly decreased with the advent of appropriate chemotherapy.