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Images in paediatrics
Periorbital chloroma mimicking raccoon eyes in a child with acute myeloid leukaemia
  1. Balaganesh Karmegaraj1,
  2. Sneha Latha M2,
  3. Ravindran Manipriya2,
  4. Sowmya Vijayakumar1,
  5. Aruna Rajendran2,
  6. Venkatadesikalu Maljetty1,
  7. Ramesh Samikannu1,
  8. Julius Xavier Scott2
  1. 1Division of Pediatrics, Rajah Muthiah Medical College and Hospital, Annamalai University, Chidambaram, Tamil Nadu, India
  2. 2Division of Pediatric Hemato-Oncology, Sri Ramachandra University, Chennai, Tamil Nadu, India
  1. Correspondence to Dr Balaganesh Karmegaraj, Department of Pediatrics, Rajah Muthiah Medical College and Hospital, Annamalai Nagar, Chidambaram 608002, Tamil Nadu, India; kbgpho{at}

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A 6-year-old boy presented with fever, purpuric rashes and a 2-week history of reddish periorbital discolouration bilaterally. On physical examination he had periorbital swelling which was palpable and surrounded by ecchymosis (raccoon eyes) (figure 1A), sternal tenderness, and hepatosplenomegaly. Blood tests revealed a haemoglobin level of 7 g/dL, platelets 23 000 cells/mm3, and a white cell count of 17 000 cells/mm3 with 70% myeloblasts with Auer rods. Flow cytometry showed blasts positive for myeloid markers CD13, CD33, CD117 and cMPO, suggesting acute myeloid leukaemia (AML) FAB-M2. Karyotyping showed t(8,21) translocation. The patient was treated with four cycles of chemotherapy with …

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  • Contributors BK: prepared the manuscript; SLM: corrected the manuscript; RM: helped with article submission; SV: took the clinical pictures; AR: helped review the literature; VM: diagnosed the disease with peripheral smear; RS: suggested improvements to the manuscript; JXS: managed the case and helped review the literature.

  • Competing interests None.

  • Parental/guardian consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.