Case 3: A 28-month-old with esotropia and acute lymphoblastic leukemia.

A previously healthy 28-month-old girl presented to the emergency department with a one-month history of pallor and bruising, and a new petechial rash. An ophthalmology consult was pending for the onset of left eye esotropia four months previously. On examination, the child was pale and irritable, although without signs of acute distress. Her height, which had always been a parental concern, was 81 cm (u003c3rd percentile) and her weight 11.8 kg (50% percentile). Her respiratory and cardiovascular examinations were unremarkable. Her abdomen was soft and tender, with obvious hepatosplenomegaly. Cervical and inguinal lymphadenopathy was noted. The central nervous system (CNS) examination confirmed left eye esotropia, with no other neurological findings.