Conjunctival chemosis or not? #OneMinuteOphthalmology
A 7-year-old girl presented with redness of the left eye since the past 4 months. She was diagnosed elsewhere with left eye conjunctival chemosis and prescribed topical steroids and lubricants. Her best-corrected visual acuity was 20/20 in both eyes.

There was left upper eyelid ptosis and a diffuse, pale pink thickening of the inferior and nasal bulbar conjunctiva, extending from the limbus to the inferior fornix with intrinsic blood vessels and small punctate hemorrhages within the lesion. Proptosis was absent, ocular motility was full and free, and the rest of the anterior segment and fundus examination were normal in both the eyes.

Incision biopsy from the conjunctival lesion revealed polymorphous infiltrate of lymphoid cells with large atypical lymphoblastic cells in the background. Immunohistochemistry identified the cells to be highly positive for terminal deoxynucleotidyl transferase and CD20, CD79a, and CD34 and negative for CD3, CD117, and MPO.

Her blood investigations showed a total leucocyte count of 8000 cells/mm3 with 27% lymphocytes and 8%–10% atypical lymphoblasts. Bone marrow biopsy showed replacement of the marrow with predominant lymphoblasts. Cerebrospinal fluid cytology was normal. Systemic examination revealed left preauricular lymphadenopathy and no organomegaly.

Final Dx: Conjunctival Extramedullary B-Lymphoblastic Lymphoma/leukemia.

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Dr. S●●●n I●i
Dr. S●●●n I●i Internal Medicine
Allergic conjunctivitis
Oct 11, 2018Like