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A 22-year-old female was admitted to our department due to sudden loss of vision of her right eye. The funduscopic examination revealed a clinical picture of venous stasis retinopathy combined with macular branch artery occlusion. The physical examination and the laboratory tests confirmed the diagnosis of systemic lupus erythematosus.

Gastrointestinal perforation is a surgical emergency in the pediatric patient and any delay in diagnosis might be hazardous. In immunocompromised children, the clinical signs of perforation may be blunted. We describe a child with acute lymphoblastic leukemia (ALL) and a perforated appendix and ileum in whom computerized tomography (CT) revealed extraluminal air that was not initially identified on plain abdominal film. Our case demonstrates the importance of early abdominal CT and ultrasound examination in detecting these potentially lethal complications.