Recurrent preseptal cellulitis seen in a leukemia girl

Abstract

Abstract

We report a case of recurrent preseptal cellulitis in a patient with acute lymphocytic leukemia (ALL). An 11-year-old female patient who was ongoing chemotherapy for ALL was referred due to left lower lid swelling, redness and pain for 4 days. Visual acuity in right eye was 6/9, left eye was 6/6. Ocular examination showed no abnormal findings, other than swelling and erythematous of left lower lid. Computed tomography showed a finding of preseptal cellulitis. She was treated with systemic and topical antibiotic for 1 week and the preseptal cellulitis was responsive to antibiotic. 4 months later, patient was admitted for neutropenic sepsis and referred again to ophthalmologist for right upper lid swelling, pain and redness for 1 day. Visual acuity were 6/6 for both eyes. Ocular examination showed no abnormal findings other than right upper lid swelling and erythematous. She was treated as right eye preseptal cellulitis with systemic and topical antibiotic. Right eye preseptal cellulitis improved and resolved after 1 weeks of antibiotic treatment.

Conclusion: Orbital infiltration is more common in acute leukemia compared to chronic leukemia. Lid involvement in leukemia could be primary direct infiltration or secondary indirect involvement. This case is unique as preseptal cellulitis reported in pertinent case reports were highlighted the considering of leukemia cutis. Recurrent preseptal cellulitis is rarely described as ongoing symptoms and in this case, it was responsive to antibiotic treatment which can be due to poor immunology status of the patient.