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.