Acute myeloid leukaemia presenting as proptosis in an infant

Paediatric patients with acute myeloid leukaemia (AML) often present with symptoms associated with the disruption of normal haematopoiesis and subsequent cellular deficiencies. Periosteal reactions are common in paediatric leukaemia, but typically manifest as a thin, laminated pattern along long bones. Aggressive periosteal reactions are much less frequently seen. Here, we report a case of paediatric AML initially presenting with proptosis and periorbital swelling caused by aggressive, sunburst periosteal reactions surrounding the sphenoid and zygomatic bones. This unique presentation emphasises the importance of considering leukaemic infiltration in the differential for sunburst periosteal reaction in paediatric patients.

NOT EVERY Q WAVE IS AN INFARCT- STEPWISE APPROACH IN A CASE OF CARDIAC AMYLOIDOSIS

We are presenting a case of 65 years old lady who presented in clinic with shortness of breath, pedal and periorbital swelling and lethargy for 1 month. Her initial electrocardiogram (ECG) raised the suspicious of a missed myocardial infarction but detailed workup confirm the diagnosis of multiple myeloma with cardiac amyloidosis. The case highlight the importance of considering differentials of various ECG pattern mimicking infarcts and correlating them clinically and with other diagnostic modalities.

Idiopathic orbital myositis in a pregnant woman

A case of a 29-year-old woman who presented at 25 weeks’ gestation with acute onset of painful diplopia and periorbital swelling is presented. Following further investigation, a diagnosis of idiopathic acute lateral rectus myositis was established. Her condition resolved following a 4-week course of oral prednisolone without recurrence. A healthy female was delivered at 40 weeks’ gestation. The presenting features, differential diagnosis, treatment and course of orbital myositis are discussed.

Radiological spectrum of invasive mucormycosis in COVID-19

Mucormycosis, commonly known as the “black fungus” is recently emerging as a deadly complication in COVID patients in the Indian subcontinent. A growing number of cases are being reported from all over the country, with a majority of the patients either undergoing treatment or having recovered from COVID. Here, we report three cases of multisystem mucormycosis in COVID positive patients showing, rhino-orbital, cerebral, pulmonary, and genitourinary involvement. The first is a case of a 41-year-old male patient who during his treatment developed left periorbital swelling with ecchymosis and headache. CT and CE-MRI of the paranasal sinuses and brain revealed features of pan fungal sinusitis and subsequent invasion into the left orbit. The second case is of a 52-year-old male patient who after complaining of a severe left-sided hemicranial headache was diagnosed with cavernous sinus thrombosis. The third is of a 57-year-old male patient who presented with left flank pain and dysuria. HRCT (High-resolution CT) chest revealed a thick-walled cavitary lesion, and NCCT KUB (Non-contrast CT of Kidneys, ureters, and bladder) revealed left-sided pyelonephritis. A cystoscopic and microbiological evaluation revealed fungal growth. In all three patients, a biopsy from the involved area revealed broad aseptate filamentous fungal hyphae suggestive of mucormycosis, which was confirmed on culture. These are all unusual cases and physicians should be aware of the possibility of secondary invasive fungal infections in patients with COVID-19 infection.

Presentación atípica de celulitis orbitaria en recién nacido

Orbital cellulitis represents a frequent cause of inflammation of the orbit, constituting a medical emergency that requires multidisciplinary management. We present a case of a newborn with clinic of volume increase in right bipalpebral region and fever of 24 hours of evolution. Physical examination reveals proptosis of right eye, increase of bipalpebral volume that prevents the opening of the eyeball in its entirety with signs of flushing and purulent eyelid margin secretion. Laboratories report leukocytosis and reactive thrombosis; orbital tomography scan shows right periorbital swelling and edema, diffuse increase of extra and intraconal post-septal fat density, suggestive findings of right orbital cellulitis, covered with vancomycin and cefotaxime; subsequently requires abscess drainage where Staphylococcus aureus methycilin- resistant is isolated. Being an unusual pathology in this age group, the publication of this case is recommended. Key word: Celullitis, orbital abcess, new born

Anomalous Facial Nerve in a Case of Atticoantral Chronic Otitis Media with Mastoid Abscess

An 18 years old female patient came to emergency medicine department on 3rd July 2020 in the evening hours with massive swelling extending in front, above and behind left ear. Associated with severe, throbbing, intermittent headache since past 4 days patient also had high grade fever. Patient also had a history of left ear foul smelling discharge, scanty in amount, non-blood tinged, not aggravated or relieved with upper respiratory tract infection (URTI), not relieved with medications and not associated with giddiness. Clinical examination revealed a swelling in left preauricular region extending to temporoparietal region displacing left pinna downwards and outwards. Bilateral periorbital swelling was present (Figure 2, 3). Mastoid tenderness was conspicuous. Whitish foul smelling, non-blood-tinged discharge was present in left external auditory meatus. Further ear examination was not possible due to oedema, swelling and thick discharge in external auditory canal (EAC). In view of extensive swelling with its epicenter in mastoid region, left unsafe chronic otitis media (COM) with complication was suspected and was admitted to ENT ward. General investigations were normal except leucocytosis. While patient was put on antibiotics, neurosurgical opinion was sought and magnetic resonance imaging (MRI) brain with contrast was planned to map the abscess. MRI (Figure 1) which was suggestive of left squamosal COM and mastoiditis with intracranial extradural abscess in left temporoparietal region. MRI also uncovered large subgaleal abscess in the left temporo-occipito-parietal region along the sternocleidomastoid (SCM) muscle with thrombosis of left transverse and sigmoid sinus. Neurosurgeons found no need for intervention from their side.

Delayed Sudden Blindness From Unilateral Ophthalmic Artery Vasospasm Following Endoscopic Sinus Surgery?

Keywords: ophthalmic artery; vasospasm; iatrogenic; endoscopic sinus surgery; blindness Endoscopic sinus surgery (ESS) is a generally benign, minimally invasive procedure used for management of paranasal sinus diseases, although complications may occur due to proximity of vital structures such as the brain, orbit and great vessels.1 The overall ESS major complication rate is 0.5-1%, of which orbital injury accounts for 0.09% due to direct trauma.2 We report a case of unilateral delayed sudden visual loss without orbital trauma observed intraoperatively or on post[1]operative imaging studies, following a seemingly routine endoscopic sinus surgery for chronic rhinosinusitis. CASE REPORT An 18-year-old lad with no significant medical history underwent ESS for bilateral chronic rhinosinusitis with nasal polyposis. (Figure 1 A-D) The surgery and recovery from anesthesia were uneventful. On the 12th hour post-operatively, the patient noted blurring of vision on the left. Ophthalmologic examination revealed hyperemic conjunctiva (Figure 2A) with visual acuity of counting fingers at 1 foot while fundoscopy showed retinal hemorrhages. Extraocular eye movements (EOM) and intraocular pressure (IOP) were normal (12mmHg). With an assessment of pre-retinal hemorrhages, 500 mg Tranexamic acid was intravenously infused, and a paranasal sinus (PNS) computed tomography (CT) scan and orbital magnetic resonance imaging (MRI) were requested. A few hours later, he complained of left eye pain with increasing intensity and further deterioration of vision. Repeat visual acuity testing showed light perception. There was now a constricted pupil, non-reactive pupillary light reflex, periorbital swelling and progression of conjunctival chemosis. (Figure 2B) The IOP of the left eye had increased to 30mmHg then progressed to 40mmHg with development of total visual loss and a lateral gaze limitation. With an impression of choroidal hemorrhage and retrobulbar hemorrhage, a lateral canthotomy relieved the eye pain. The contrast PNS CT scan with orbital cuts showed that the lamina papyracea was intact with no definite hemorrhagic collections in the intraconal or extraconal spaces of both orbits. (Figure 3A, B) A small hyper density along the lateral inferior margin of the left globe at the intraconal region with slight thickening of the anterior periorbital region represented the lateral canthotomy. The PNS MRI / magnetic resonance angiography (MRA) with orbital cuts showed retinal detachment and periorbital edema in the left eye. (Figure 4) A B-Scan ocular ultrasonogram showed retinal detachment and vitreous opacities. The diagnosis was ocular ischemic syndrome secondary to ophthalmic artery vasospasm, and the patient was given sublingual nitroglycerine and intravenous dexamethasone 8mg every 12 hours for 24 hours, with improvement of periorbital swelling. He was discharged after 12 days with no resolution of the unilateral visual loss.

Unilateral periorbital swelling in children: avoid delays in diagnosis

A 10-year-old child had painful periorbital swelling in the left eye. It was diagnosed as preseptal cellulitis and treated with oral antibiotics. Three days later, the ocular condition worsened so the child was referred for further management. On examination, the child had a temperature of 102 °F. Ocular examination revealed proptosis, restricted ocular movements and a relative afferent pupillary defect in the left eye. Ocular examination of the right eye was normal. There was a history of recurrent episodes of cold in the past. CT scan orbit and sinuses revealed signs of orbital cellulitis with sinusitis on the left side. The child was treated with parenteral antibiotics and endoscopic sinus surgery. A child presenting with unilateral periorbital swelling needs to be thoroughly evaluated. It is important to differentiate orbital cellulitis from preseptal cellulitis. Orbital cellulitis is an emergency and delay in diagnosis can lead to vision and life-threatening intracranial complications.

Avian Mycobacteriosis and Molecular Identification of Mycobacterium avium Subsp. avium in Racing Pigeons (Columba livia domestica) in Greece

In this report, cases of avian mycobacteriosis in two lofts of racing pigeons are described. Three racing pigeons of 2-year old from the first loft (A) and four racing pigeons of 4–5 years old from the second loft (B) were submitted to the Unit of Avian Medicine for clinical examination and necropsy. In the case history chronic and debilitating disease was reported. The clinical signs included emaciation, depression, lameness, periorbital swelling and diarrhea, although the appetite was normal. Post mortem lesions involved an enlarged spleen with multiple different sized yellow nodules. Similar lesions were also observed in the liver, conjunctiva of the inferior eyelids and in the femoral bone marrow. The suspicion of avian mycobacteriosis was based on history, clinical signs and typical lesions. In order to confirm the diagnosis, histopathology was performed on tissue sections and revealed the presence of multiple granulomas with central necrosis. In addition, Ziehl-Neelsen positive bacilli were observed in histological sections and smears from the granulomas of the affected tissues. Molecular analysis identified the causative agent as Mycobacterium avium subsp. avium. This is the first case report of avian mycobacteriosis in Greece, which describes the presence of granulomatous conjunctivitis and the molecular identification of M. avium subsp. avium as the causative agent in racing pigeons.

Adenoid Cystic Carcinoma of the Lacrimal Gland: A Case Report of Rare Entity

Adenoid cystic carcinomas have specific pathologic features that correlate with prognosis. In general, adenoid cystic carcinomas are aggressive tumours with poor prognosis. Treatment most commonly includes surgery with or without radiation and chemotherapy. We describe a patient who presented with right periorbital swelling and CT Face contrast showing well defined soft tissue dense heterogeneously enhancing mass lesion seen along medial wall of right orbital region. The tumour was excised, and pathologic analysis showed an adenoid cystic carcinoma of the lacrimal gland. We review the clinical, radiographic, and pathologic features of these rare malignant tumours as well as treatment options.