Journal of Pediatric Ophthalmology and Strabismus

Whats Your Diagnosis 

More Than Bruising and Blurry Vision

Hanna M. Prendeville, BA; Helen H. Yeung, MD

Abstract

A 7-year-old boy was seen by his primary care physician for complaints of fatigue, headaches, bruising, achy joints for 1 week, and mildly blurry vision for the past 3 days. The patient's primary care physician observed mild redness in both eyes and referred the patient to a pediatric ophthalmologist. The parents reported slight redness in both eyes for the past few weeks, and the patient said his eyes occasionally hurt and his vision was now blurry. On examination, good fixation and following was demonstrated and visual acuity was 20/40 in each eye. The anterior segments were clear with normal irides and reacting pupils. His intraocular pressure was 14 mm Hg in both eyes. A dilated fundus examination was conducted. Small white masses and retinal hemorrhages were seen in the left (Figure 1A) and right (Figure 1B) eyes. The patient was referred to a pediatric oncologist and bloodwork was ordered. Results included hemoglobin levels at 6.9 g/dL, hematocrit at 18%, platelets at 30 k/mL, and a white cell count over 100.0 k/mm3.

For the correct answer, see page 377.

The answer for What's Your Diagnosis? is childhood acute lymphocytic leukemia.…

A 7-year-old boy was seen by his primary care physician for complaints of fatigue, headaches, bruising, achy joints for 1 week, and mildly blurry vision for the past 3 days. The patient's primary care physician observed mild redness in both eyes and referred the patient to a pediatric ophthalmologist. The parents reported slight redness in both eyes for the past few weeks, and the patient said his eyes occasionally hurt and his vision was now blurry. On examination, good fixation and following was demonstrated and visual acuity was 20/40 in each eye. The anterior segments were clear with normal irides and reacting pupils. His intraocular pressure was 14 mm Hg in both eyes. A dilated fundus examination was conducted. Small white masses and retinal hemorrhages were seen in the left (Figure 1A) and right (Figure 1B) eyes. The patient was referred to a pediatric oncologist and bloodwork was ordered. Results included hemoglobin levels at 6.9 g/dL, hematocrit at 18%, platelets at 30 k/mL, and a white cell count over 100.0 k/mm3.

What's Your Diagnosis?

For the correct answer, see page 377.

The answer for What's Your Diagnosis? is childhood acute lymphocytic leukemia.

References

  1. Schachat AP, Markowitz JA, Guyer DR, Burke PJ, Karp JE, Graham ML. Ophthalmic manifestations of leukemia. Arch Ophthalmol. 1989;107(5):697–700. doi:10.1001/archopht.1989.01070010715033 [CrossRef]
  2. Smithson WA, Gilchrist GS, Burgert EO Jr, . Childhood acute lymphocytic leukemia. CA Cancer J Clin. 1980;30(3):158–181. doi:10.3322/canjclin.30.3.158. [CrossRef]
  3. Kuwabara T. Leukemic miliary nodules in the retina. Arch Ophthalmol. 1964;72:494–497. doi:10.1001/archopht.1964.00970020494010 [CrossRef]
Authors

From Children's Glaucoma Foundation, Boston, Massachusetts (HMP); and the Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts (HHY).

The authors have no financial or proprietary interest in the materials presented herein.

Correspondence: Hanna M. Prendeville, BA, Children's Glaucoma Foundation, 2 Longfellow Place Suite 201, Boston, MA 02114. Email: hprendeville.cgf@gmail.com

10.3928/01913913-20201013-01

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