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Clinical introduction
A 65-year-old woman presented with head and facial trauma after a fall from standing height. Her vital signs were normal, and physical examination revealed right-sided facial contusions and bilateral periorbital ecchymoses (ie, a raccoon sign or panda eyes) ( figure 1 ). She denied a headache and orbital pain. Head computed tomography (CT) was performed, but no skull fracture, periorbital haematoma, encephalorrhagia, punched-out lesion or tumour was detected. Laboratory data indicated kidney dysfunction. The patient reported that the non-painful periorbital skin lesion developed over a period of 1-2 years.
Question
What is the most likely diagnosis? Kaposi's sarcoma
Amyloid light-chain amyloidosis
Multiple myeloma
Neuroblastoma
Answer: B
Amyloid light-chain (AL) amyloidosis . The abdominal fat pad and bone marrow puncture revealed AL amyloidosis, and the patient began chemotherapy. Raccoon eyes, a clinical sign that is most commonly associated with a basilar skull fracture, is observed in unilateral and bilateral orbital fractures in patients who present to the emergency department. 1 Beyond trauma, the differential diagnosis most commonly includes metastatic neuroblastoma, Kaposi's sarcoma, multiple myeloma and amyloidosis. 2-4 The skin lesions...