Extensive Forehead Swelling Including the Periorbital Area in a Child: A Rare Manifestation of Acute Lymphoblastic Leukemia

Abstract

Acute lymphoblastic leukemia (ALL) manifestations in a child are varied. We report a unique and rare presentation of acute lymphoblastic leukemia in a child who presented with frontal swelling involving bilateral upper lids. A previously healthy one-year-old girl presented with progressively increasing frontal swelling of seven months duration. An examination revealed erythematous, firm, nontender forehead swelling that extended up to the medial part of bilateral upper eye lids. The extraocular muscle movement was normal. The anterior segment and fundus examination were also normal in both eyes. Other systemic examination revealed multiple leukemic cutis on the scalp. The cervical lymph nodes were also palpable with hepatosplenomegaly. A full blood picture (FBP) showed the presence of leucoerythroblastic blood film with 62% blast cells. Flow cytometry and bone marrow aspiration confirmed the diagnosis. Computed tomographic (CT) scan images revealed multiple well-defined hyperdense lesions at the subcutaneous skull with the largest lesion at the anterior glabella. Upon diagnosis, the patient was started on chemotherapy and the swelling resolved after one month post treatment. Extensive forehead swelling is a rare manifestation of acute lymphoblastic leukemia. A high index of suspicion aided with diagnostic investigations could help the doctors arrive at a correct diagnosis and treatment.

Acute onset facial oedema: an unusual presentation of acute lymphoblastic leukaemia in a child

“…There are case reports of subacute orbital or periorbital swelling as a presentation of childhood leukaemia,1–12 but these were due to a radiologically evident local mass. A further case report of chronic forehead swelling was due to leukaemic skin infiltration and multiple bony frontal skull lesions 13. However, presentation with facial oedema of acute onset in the absence of a local mass is not described elsewhere in the literature.…”