Subperiosteal orbital hemorrhage as initial manifestation of Christmas disease (factor IX deficiency).
OBJECTIVE
To report a case of subperiosteal orbital and subgaleal hemorrhage with optic nerve compromise in a patient with a factor IX deficiency.


METHODS
Interventional case report.


METHODS
A 5-year-old male presented 10 days after mild trauma with progressive left-sided scalp swelling, proptosis, and visual loss.


RESULTS
The patient had marked proptosis of the left eye, 20/200 visual acuity, and an afferent pupillary defect. Magnetic resonance imaging demonstrated a large subgaleal and left subperiosteal orbital hematoma. Quantitative assays of coagulation proteins identified a factor IX deficiency (Christmas disease).


CONCLUSIONS
Delayed-onset subgaleal and subperiosteal orbital hematoma can rarely be an initial manifestation of Christmas disease.
Guirgis
Medhat F
MF
Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA.
Segal
William A
WA
Lueder
Gregg T
GT
D002675:Child, Preschool; D019299:Decompression, Surgical; D005164:Factor IX / Q000627:therapeutic use; D006406:Hematoma / Q000175:diagnosis* / Q000601:surgery; D002836:Hemophilia B / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019315:Retrobulbar Hemorrhage / Q000175:diagnosis* / Q000601:surgery
D005164:Factor IX