Observation 2:
A 6-year-old patient was admitted for a hemorrhagic syndrome with
ecchymotic spots, especially on the lower limbs, and an infectious
syndrome with a fever of 38.5°C associated with hypoacusis. On clinical
examination, hepatomegaly, infra-centimetric cervical and thoracic
adenopathies and bilateral exophthalmos were found. The blood count on
admission revealed severe bicytopenia (hemoglobin level: 5.7 and
platelet count: 23,000/mm³) and hyperleukocytosis (white blood cells:
196170/mm³). The tumor lysis test was negative. The myelogram showed an
infiltration of blasts estimated at 31% and hypoplasia of the
erythroblastic lineage (figure 2), cytochemical staining for peroxidase
was positive. Lymphocyte immunophenotyping on marrow blood showed a low
CD45 blast population estimated at 36% of myeloid phenotype (figure 3,
4). The karyotype showed the presence of the Ph chromosome, completed by
the molecular study, which confirmed the presence of the BCR-ABL1
transcript. The child was treated according to the AML-MA 2011 protocol,
DTT, and she presented a febrile neutropenia put on triaxon + gentamicin
during 48h with persistence of fever and increase of CRP from where the
decision to switch the antibiotic therapy to ciproxine + amiklin +
vancomycin. The follow-up cerebral CT scan of the orbit shows a
significant regression of tissue infiltration of the bilateral external
orbital walls with complete regression of the exophthalmos.