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Vol. 40. Núm. 2.Abril - Junho 2018
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Vol. 40. Núm. 2.Abril - Junho 2018
Páginas 99-198
Images in Clinical Hematology
DOI: 10.1016/j.htct.2017.12.001
Reversible proptosis due to a hematological cause
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Ram V. Nampoothiri, Ankur Jain, Pankaj Malhotra
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pgimerhemat@gmail.com

Corresponding author at: Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India. Tel.: +91 172 275 6680/275 6671.
Institute of Medical Education and Research, Chandigarh, India
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This 18-year-old-boy was diagnosed with chronic myeloid leukemia (CML) – chronic phase non-complaint to treatment. He recently presented with progressive fatigue and increasing prominence of both eyes. On examination, he had bilateral proptosis, left more than right, with pus discharge (Figure 1A). He had pallor and splenomegaly. A complete blood count showed anemia (hemoglobin 7.6g/dL) and a raised leukocyte count (120.0×103/μL) with differential count showing a left shift. Contrast enhanced magnetic resonance imaging of the brain revealed bilateral mass lesions of the retro-orbital soft tissue (black arrows – Figure 1B) abutting the globe and involving the bones and extra-ocular muscles (Figure 1B). Fine needle aspiration cytology of the mass revealed features suggestive of granulocytic sarcoma. Bone marrow was suggestive of accelerated phase CML. The patient was treated with Dasatinib 140mg OD and 15Gy external beam radiotherapy for extramedullary blast crisis, and antibiotics for eye infection. The patient's proptosis was resolved after one month of therapy (Figure 1C) and he achieved complete hematological remission. Natural history of untreated CML is progression toward blast crisis1 and can present as extramedullary granulocytic sarcomas.

Figure 1.
(0,3MB).
Conflicts of interest

The authors declare no conflicts of interest.

Reference
[1]
J. Cortes,H.M. Kantarjian,S. Giralt,M. Talpaz
Natural history and staging of chronic myelogenous leukaemia
Baillieres Clin Haematol, 10 (1997), pp. 277-290
Copyright © 2018. Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular
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