When Ophthalmology Saves Life " Rapidly Progressive Exophthalmos As A Presenting Symptom Of Lymphoblastic B Lymphoma In A Pediatric Patient " : A Case Report

To present the clinical course, diagnostic workup, and management of a 5-year-old girl who consults for rapidly progressive exophthalmos of the left eye with abduction  limitation due to a systemic lymphoblastic B lymphoma, which involves muscle of the orbit , psoas muscle, humeral bone, and spleen. This case highlights the role of ophthalmologist in early recognition and intervention in pediatric patients with ocular manifestations of systemic malignancies.

The case was managed at a tertiary pediatric hospital with a specialized pediatric oncology unit and a multidisciplinary team, including ophthalmologists, pediatric oncologists, radiologists, and pathologists.The hospital is equipped with advanced diagnostic tools,such as high-resolution oculo-orbital MRI, and has specialized laboratories for immunohistochemical analysis.The patient's treatment was closely monitored, with regular assessments of both ocular and systemic responses to chemotherapy

A 5 year old girl presented with rapidly progressive exophthalmos with abduction limitation in the left eye,dilation of the conjunctival vessels resembling a jellyfish and a sub-axillary mass.An oculo-orbital MRI revealed tumoral infiltration of the left lateral rectus muscle.Biological assessments showed significant anemia, and fine needle aspiration of the mass confirmed the presence of malignant cells.Cytopathology combined with Immunohistochemistry identified the malignancy as lymphoblastic B lymphoma,thoracic abdominopelvic scan demonstrated infiltration of psoas muscle,an osteolytic lesion in the humerus, and splenomegaly.Hyperhydration and chemotherapy with corticosteroids and metotheraxate was used as part of the management strategy

Chemotherapy treatment resulted in a significant reduction in exophthalmos and improvement in clinical signs, including resolution of the conjunctival vessel dilation. Radiological and clinical follow-ups showed promising responses to treatment with a reduction in the size of the sub-axillary mass, psoas muscle infiltration.

Pediatric patients with rapid onset of exophthalmos and systemic signs should be evaluated for underlying malignancies, such as lymphoblastic B lymphoma. Early diagnosis and aggressive chemotherapy can lead to significant clinical improvement as observed in our patient. This case underscores the value of multidisciplinary management in addressing the ocular and systemic manifestations of lymphoma in children