title: Acute dacryocystitis as a presenting sign of pediatric leukemia.
abstract: OBJECTIVE
  To report acute dacryocystitis with preseptal cellulitis as the presenting sign of leukemia in a child.
  
  
  METHODS
  Case report and literature review.
  
  
  RESULTS
  During the initial evaluation of a 17-month-old child with epiphora, left lower eyelid swelling, and a tender left medial canthal mass, a complete blood cell count demonstrated pancytopenia. Bone marrow biopsy disclosed replacement of normal cellular architecture with a dense infiltrate of leukocyte blast forms. DNA analysis disclosed a translocation between chromosome 10 and 11, consistent with the diagnosis of nonlymphocytic leukemia. Although the adjacent lower eyelid cellulitis responded to intravenous antibiotics, lacrimal sac distention decreased only after chemotherapy was initiated.
  
  
  CONCLUSIONS
  Dacryocystitis with preseptal cellulitis can be a presenting sign of leukemia. This blood malignancy should be considered in patients whose leukocyte counts do not correlate with their clinical presentation.
authors.affiliation: Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, USA. wirostko@mcw.edu
authors.forename: W J
authors.initials: WJ
authors.lastname: Wirostko
authors.forename: G H
authors.initials: GH
authors.lastname: Garcia
authors.forename: S
authors.initials: S
authors.lastname: Cory
authors.forename: G J
authors.initials: GJ
authors.lastname: Harris
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D002481:Cellulitis / Q000175:diagnosis* / Q000188:drug therapy; D002879:Chromosomes, Human, Pair 10 / Q000235:genetics; D002880:Chromosomes, Human, Pair 11 / Q000235:genetics; D004273:DNA, Neoplasm / Q000032:analysis; D003607:Dacryocystitis / Q000175:diagnosis* / Q000188:drug therapy; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005141:Eyelid Diseases / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007223:Infant; D007765:Lacrimal Apparatus / Q000000981:diagnostic imaging; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis* / Q000188:drug therapy / Q000235:genetics; D009300:Nasal Septum / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014178:Translocation, Genetic
chemical_list: D000900:Anti-Bacterial Agents; D004273:DNA, Neoplasm