Acute dacryocystitis as a presenting sign of pediatric leukemia

PURPOSE: To report acute dacryocystitis with preseptal cellulitis as the pr esenting sign of leukemia in a child. METHODS: Case report and literature review. RESULTS: During the initial evaluation of a 17-month-old child with epiphor a, left lower eyelid swelling, and a tender left medial canthal mass, a com plete blood cell count demonstrated pancytopenia. Bone marrow biopsy disclo sed replacement of normal cellular architecture with a dense infiltrate of leukocyte blast forms. DNA analysis disclosed a translocation between chrom osome 10 and 11, consistent with the diagnosis of nonlymphocytic leukemia. Although the adjacent lower eyelid cellulitis responded to intravenous anti biotics, lacrimal sac distention decreased only after chemotherapy was init iated. CONCLUSIONS: Dacryocystitis with preseptal cellulitis can be a presenting s ign of leukemia. This blood malignancy should be considered in patients who se leukocyte counts do not correlate with their clinical presentation. (Am J Ophthalmol 1999;127:734-736. (C) 1999 by Elsevier Science Inc. All rights reserved.).