Acute visual loss as the initial presentation in a child with systemic Burkitt lymphoma
We report a case of a 3-year-old boy with acute visual loss in both eyes, who had been diagnosed with stage IV NHL with bone marrow, abdominal and CNS involvement. The child was admitted with complaint of acute blindness in both eyes without a remarkable past medical history. In funduscopy, his pupils were fixed at 6 mm in diameter without light perception. Cranial magnetic resonance imaging (MRI) demonstrated masses arising within the sphenoid sinus and invading the orbits and ethmoidal sinuses causing bilateral compression on optic nerves [] The diagnosis of B-NHL was defined cytologically and immunologically in the bone marrow aspirates and cerebrospinal fluid (CSF). Abdominal computed tomography also depicted tumoral infiltration of the kidneys and abdominal lymphadenopathy. His acute blindness was attributed to optic nerve compression in addition to the high proliferation rate characteristic to Burkitt lymphoma. Once the diagnosis was established, he started therapy according to the UKCCSG 9003 protocol. Response to chemotherapy was monitored by appropriate restaging investigations after COP and CYVE II. The boy did not show any visual improvement but some slight light perception despite his partial remission after CYVE II as depicted in restaging investigations. Unfortunately, he relapsed in the CNS and died secondary to neutropenic septicemia 6 months after diagnosis before his scheduled radiotherapy without ever achieving complete remission.