Spontaneous periorbital ecchymosis: a rare presentation of acute lymphoblastic leukaemia

Description

A 45-year-old woman presented with spontaneous discolouration around the left eye for 1week. She also gave a history of easy fatigability for 1month. There was no history of any preceding injury in the head and neck area. She denied any headache, vomiting or visual disturbances. Examination showed hepatosplenomegaly and ecchymosis around the left eye (raccoon eye), along with subconjunctival haemorrhage ( figure 1A ). Her fundus examination was unremarkable. Her haemoglobin was 138g/L, white blood cell count was 51×10⁹/L and platelet was 19×10⁹/L. Her peripheral blood smear had 24% blast with CD34, CD10 and CD19 positivity on flow cytometry, confirming a diagnosis of acute lymphoblastic leukaemia. A biopsy from the periorbital area could not be done...