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Dr. James
Dr. James, Board Certified Ophthalmologist
Category: Eye
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Experience:  Eye Physician and Surgeon
20222826
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A 41 yr old male being treated for leukemia, which is in remission,

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A 41 yr old male being treated for leukemia, which is in remission, developed a septic infection after his last round of chemo. He was being treated successfully but one of his eyelids started to droop. Upon further examination by MRI, the doctors hypothesized that there might be a "leaking" abscess behind the eye. They recommend an eye biopsy in order to rule out cancer since they do not feel that his bone marrow and spinal taps indicate that his cancer has spread. He and his wife are at odds about the biopsy? Do you have an opinion on this complex case?
Submitted: 6 years ago.
Category: Eye
Expert:  Dr. James replied 6 years ago.
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Dr. James :

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Dr. James :

What treatment has had for this new mass?
When did the eyelid droop appear?
Is it a complete droop where the eye is not visible unless the eyelid if physically lifted?
Is that eye able to move left/right/up/down?
How long has he been in remission?

Dr. James :

Are you still there?

Customer:

He is a patient at Georgetown Medical and was a former chem. student and close friend when he was in high school. He had treatment for the septic infection, but to my knowldge , has had no treatment for the suspected mass/abscess? An eye surgeon is scheduled to do a biopsy on Thursday. HIS VISION IS NOT IMPAIRED BUT THE MUSCLE CONTROLLING THE EYELID IS THE PROBLEM. I JUST FOUND OUT THAT HIS INFECTION WAS A STREP. WHICH QUICKLY, BECAUSE OF HIS POOR BODY DEFENSES CAUSED A HIGH FEVER AND VERY LOW BLOOD PRESSURE.

Customer:

YES- I JUST REPLIED.

Expert:  Dr. James replied 6 years ago.
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Expert:  Dr. James replied 6 years ago.
Thank you for the additional information.

With the history of a systemic strep infection, an abscess is likely. An abscess is the body's attempt to wall off or quarantine an area of infection. This is good because it prevents that collection of bacteria to spread, but bad because it keeps the body's immune system from getting access to it to fight it off and be rid of it.

Surgery would do two things. It can help rid the infection by physically draining the abscess. It will also confirm that it is an infection and not a recurrence of the leukemia.

There are certainly risks because it is such a sensitive area. If the surgeon feels confidant that he is able to safely access it, then that would be the treatment of choice. A second approach may be to presumptively treat it as an infection with antibiotics and repeat the MRI to see if it gets smaller. If no improvement, then go to surgical drainage.

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