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Corneal perforation with preseptal cellulitis in a patient with acute lymphocytic leukemia.

Im SK, Yoon KC - J. Korean Med. Sci. (2010)

Bottom Line: Corneal melting and perforation with iris prolapse were detected in the right eye on the 16th day.Emergent tectonic keratoplasty was performed.Seven months after surgery, visual acuity in the right eye was 20/300, and the corneal graft was stable.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, Korea.

ABSTRACT
We report a case of corneal perforation with preseptal cellulitis in a patient with acute lymphocytic leukemia (ALL). A 17-yr-old female patient who was undergoing combination chemotherapy for ALL was referred due to upper lid swelling and pain in the right eye for 2 days. Visual acuity in the right eye was 20/20. Initial examination showed no abnormal findings, other than swelling of the right upper eyelid. Computed tomography showed a finding of preseptal cellulitis. Microbiologic study of bloody and purulent discharge revealed Serratia marcescens. Corneal melting and perforation with iris prolapse were detected in the right eye on the 16th day. Emergent tectonic keratoplasty was performed. Seven months after surgery, visual acuity in the right eye was 20/300, and the corneal graft was stable.

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Slit lamp photographs in a 17-yr-old female patient receiving systemic chemotherapy for acute lymphocytic leukemia. (A) Marked congestion and inflammation of the upper tarsal conjunctiva and a melting lesion with sharp demarcation observed in the upper part of the cornea. (B) The iris was prolapsed at the perforated site.
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Figure 1: Slit lamp photographs in a 17-yr-old female patient receiving systemic chemotherapy for acute lymphocytic leukemia. (A) Marked congestion and inflammation of the upper tarsal conjunctiva and a melting lesion with sharp demarcation observed in the upper part of the cornea. (B) The iris was prolapsed at the perforated site.

Mentions: A 17-yr-old female patient undergoing systemic chemotherapy for ALL was referred to our hospital due to swelling and pain of the right upper lid for two days. Laboratory examination showed leukocytes 40 cells/µL, erythrocytes 3.6×103 cells/µL, hemoglobin 10.8 g/dL, hematocrit 30.6%, and thrombocytes 33×103 cells/µL. The patients received induction chemotherapy (vincristine, prednisolone, daunorubicin, and L-asparaginase). Visual acuity in the right eye was 20/20. There were no abnormal findings, other than diffuse swelling of the right upper eyelid. Orbital computed tomography showed findings of preseptal cellulitis in the right upper lid. Intravenous empirical antibiotics (teicoplanin, meropenem, and amphotericin B) were administered. Serratia marcescens was isolated from blood culture on the following day. Slit lamp examination on the 7th day revealed superficial punctate erosions in both corneas. Artificial tear eye drops were used for the treatment of superficial punctate erosions. On the 12th day, spontaneous bloody and purulent discharge from the upper palpebral conjunctiva occurred in the right eye. The patient was treated with topical levofloxacin eyedrops. Culture from the discharge was isolated from S. marcescens. Systemic antibiotics (meropenem) were maintained per the antibiotic sensitivity test. On the 16th day, periorbital swelling decreased, however, corneal melting and perforation with iris prolapse was noted in the right eye (Fig. 1). Emergent tectonic keratoplasty was performed. Seven months after surgery, visual acuity in the right eye was 20/300, and intraocular pressure was 14 mmHg. The corneal graft was stable, with mild haziness.


Corneal perforation with preseptal cellulitis in a patient with acute lymphocytic leukemia.

Im SK, Yoon KC - J. Korean Med. Sci. (2010)

Slit lamp photographs in a 17-yr-old female patient receiving systemic chemotherapy for acute lymphocytic leukemia. (A) Marked congestion and inflammation of the upper tarsal conjunctiva and a melting lesion with sharp demarcation observed in the upper part of the cornea. (B) The iris was prolapsed at the perforated site.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908803&req=5

Figure 1: Slit lamp photographs in a 17-yr-old female patient receiving systemic chemotherapy for acute lymphocytic leukemia. (A) Marked congestion and inflammation of the upper tarsal conjunctiva and a melting lesion with sharp demarcation observed in the upper part of the cornea. (B) The iris was prolapsed at the perforated site.
Mentions: A 17-yr-old female patient undergoing systemic chemotherapy for ALL was referred to our hospital due to swelling and pain of the right upper lid for two days. Laboratory examination showed leukocytes 40 cells/µL, erythrocytes 3.6×103 cells/µL, hemoglobin 10.8 g/dL, hematocrit 30.6%, and thrombocytes 33×103 cells/µL. The patients received induction chemotherapy (vincristine, prednisolone, daunorubicin, and L-asparaginase). Visual acuity in the right eye was 20/20. There were no abnormal findings, other than diffuse swelling of the right upper eyelid. Orbital computed tomography showed findings of preseptal cellulitis in the right upper lid. Intravenous empirical antibiotics (teicoplanin, meropenem, and amphotericin B) were administered. Serratia marcescens was isolated from blood culture on the following day. Slit lamp examination on the 7th day revealed superficial punctate erosions in both corneas. Artificial tear eye drops were used for the treatment of superficial punctate erosions. On the 12th day, spontaneous bloody and purulent discharge from the upper palpebral conjunctiva occurred in the right eye. The patient was treated with topical levofloxacin eyedrops. Culture from the discharge was isolated from S. marcescens. Systemic antibiotics (meropenem) were maintained per the antibiotic sensitivity test. On the 16th day, periorbital swelling decreased, however, corneal melting and perforation with iris prolapse was noted in the right eye (Fig. 1). Emergent tectonic keratoplasty was performed. Seven months after surgery, visual acuity in the right eye was 20/300, and intraocular pressure was 14 mmHg. The corneal graft was stable, with mild haziness.

Bottom Line: Corneal melting and perforation with iris prolapse were detected in the right eye on the 16th day.Emergent tectonic keratoplasty was performed.Seven months after surgery, visual acuity in the right eye was 20/300, and the corneal graft was stable.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, Korea.

ABSTRACT
We report a case of corneal perforation with preseptal cellulitis in a patient with acute lymphocytic leukemia (ALL). A 17-yr-old female patient who was undergoing combination chemotherapy for ALL was referred due to upper lid swelling and pain in the right eye for 2 days. Visual acuity in the right eye was 20/20. Initial examination showed no abnormal findings, other than swelling of the right upper eyelid. Computed tomography showed a finding of preseptal cellulitis. Microbiologic study of bloody and purulent discharge revealed Serratia marcescens. Corneal melting and perforation with iris prolapse were detected in the right eye on the 16th day. Emergent tectonic keratoplasty was performed. Seven months after surgery, visual acuity in the right eye was 20/300, and the corneal graft was stable.

Show MeSH
Related in: MedlinePlus