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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 …
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.