RESUMEN
A 9-year-old girl with a history of acute lymphoblastic leukemia in remission presented with a right subconjunctival mass and ipsilateral preauricular lymphadenopathy despite normal findings on blood cell profile. Excisional biopsy of the lesion was performed to exclude extramedullary relapse of acute lymphoblastic leukemia. Histopathologic examination showed infiltration of leukemic cells at the conjunctival substantia propria. The patient was referred to her oncologist, and bone marrow aspiration showed medullary relapse of acute lymphoblastic leukemia for which systemic and intrathecal chemotherapy was administered. Leukemic infiltration of the conjunctiva in the presence of normal findings on blood cell profile can be a rare manifestation of relapsed acute lymphoblastic leukemia.
RESUMEN
Nocardia keratitis occurred in 4 eyes of 3 patients (2 women and 1 man) who had photorefractive keratectomy (PRK) by the same surgeon at the same center. Two eyes of the first 2 patients required lamellar keratectomy to debulk the involved stroma and obtain specimens for microbiological and histopathological evaluation. Light microscopic examination disclosed gram-positive and acid-fast filaments of Nocardia that were confirmed by the microbiological results. Diagnosis of Nocardia keratitis in the third case was not as challenging as in the first 2 cases because of a high index of suspicion. Confocal scans of all cases disclosed hyperreflective and slender, fibril-like structures in the corneal stroma. All eyes responded favorably to topical amikacin and the infection resolved without recurrence. The most probable cause of the outbreak was inadequate attention to sterility during surgery.