Neurosensory detachment in acute myeloid leukemia (original) (raw)
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Bilateral Macular Serous Retinal Detachment Revealing Acute Myeloblastic Leukemia
Retinal Cases & Brief Reports, 2013
Purpose: To report a case of bilateral serous retinal detachment revealing acute myeloblastic leukemia. Methods: A 31-year-old man presenting with decreased vision in both eyes, 20/50 in the right eye and 20/32 in the left eye, was submitted to a complete ophthalmologic and systemic evaluation. Results: Fundus biomicroscopy, fluorescein and indocyanine green angiography, and spectral domain optical coherence tomography showed bilateral serous retinal detachment and signs of choroidal ischemia. Enhanced depth imaging spectral domain optical coherence tomography allowed a precise examination of the choroid, by showing an overall thickening of the choroid (749 mm in the right eye and 728 mm in the left eye) and disappearance of the normal hyporeflective visualization of the choroidal vessels. On systemic investigation, the patient was diagnosed with acute myeloblastic leukemia. After systemic chemotherapy, visual acuity improved to 20/20 in both eyes, with resolution of the bilateral serous retinal detachment and choroidal changes. Conclusion: Bilateral serous retinal detachment may be a presenting sign of acute myeloblastic leukemia. Examination of the choroid using enhanced depth imaging spectral domain optical coherence tomography may suggest the etiology and contribute to early diagnosis and treatment.
Turkish Journal of Hematology, 2012
Ocular findings are rarely the initial symptom of leukemia, although up to 90% of all leukemia patients have fundus changes during the course of the disease. Herein we report a relapsing acute lymphoblastic leukemia patient with the sole presentation of sudden visual loss and exudative retinal detachment. An 8-year-old boy with acute lymphoblastic leukemia developed sudden visual loss during his first remission period. Bullous retinal detachment with total afferent pupillary defect was observed. Orbital magnetic resonance imaging revealed an intraocular mass lesion; simultaneously obtained bone marrow and cerebrospinal fluid samples showed no evidence of leukemic cells. Following local irradiation, and systemic and intrathecal chemotherapy the mass disappeared. Local irradiation, and systemic and intrathecal chemotherapy effectively controlled the isolated ocular relapse of acute lymphoblastic leukemia and eliminated the need for enucleation.
Unilateral Eye Findings: A Rare Herald of Acute Leukemia
Ocular Oncology and Pathology, 2016
Background/Aim: Unilateral choroidal infiltration as the initial manifestation of leukemic relapse in adults is rare, particularly after an extended period of remission. This report describes this unique ophthalmic presentation, highlights the associated diagnostic challenges, and reviews the literature. Methods: Two cases are described and an extensive literature review was conducted. Results: A 59-year-old male with acute lymphoid leukemia, in remission for 18 months, presented with unilateral scleritis, exudative retinal detachment, and choroidal thickening. A 57-year-old male with a history of acute myeloid leukemia, in remission for 4 years, presented with unilateral choroidal thickening leading to secondary angle closure. In both cases, there was a significant lag from the onset of eye symptoms to establishing a systemic diagnosis of acute leukemia, leading to a delay in definitive systemic treatment, despite a high suspicion of disease based on ophthalmic findings. Conclusion...
Ocular manifestations of acute myeloid leukaemia
IP innovative publication pvt ltd, 2020
Aim: Each and every ocular tissue may be affected in leukemia and ocular involvement is a known entity since a long time . Prevalence of ocular involvement in leukemia ranges from 9% to 90% and can result from primary/direct infiltration of ocular tissues by leukemic cells or secondary/indirect involvement following systemic leukemic involvement. Materials and Methods: We present a case of a 30 years old female presented to emergency opd with history of epistaxis, low grade fever and headache from last 1 month and blurring of vision bilaterally from last 3-4 days. Examination reveals pallor, pedal edema, raised jugular venous pressure and hepatosplenomegaly. Hematology shows Hb - 4.1gm%,platelet count- 9000/mm3, total leucocyte count - 11,000/mm3 ,international normalized ratio -2.02,elevated lymphocytes(82%) and deranged liver function tests. Peripheral smear shows microcytic hypochromic anaemia having metamyelocytes 3%, blast cells 71% with negative myeloperoxidase and periodic acid Schiff. Results: Visual acuity was finger counting at one metres in both eyes. On slit lamp examination,there were bilateral diffuse subconjunctival hemorrhages, clear cornea, quite anterior chamber and anterior vitreous. Ocular movements were full and pupils were reactive bilaterally. Fundus examination in right eye shows dense intraretinal hemorrhages with central clearing in superior and inferior temporal arcade with macular hemorrhage and severe macular edema. In left eye, a large preretinal hemorrhage in superonasal and superotemporal arcade with vitreous hemorrhage was present along with multiple scattered intraretinal hemorrhages and severe macular hemorrhage with macular edema. Patient was diagnosed of having leukemic retinopathy with macular edema in a case of acute myeloid leukaemia. Conclusions: All leukemia patients should have an ocular acessment and examination at diagnosis and at least every 6 months . Ophthalmologist may have a secondary role in the treatment of leukemias but proper recognition of the ocular manifestations is crucial in the management of a case of leukemia.
Isolated Infiltrative Optic Neuropathy in an Acute Lymphoblastic Leukemia Relapse
Cureus
Optic nerve infiltration as the first sign of isolated central nervous system relapse of acute lymphoblastic leukemia (ALL) is rare. A seven-year-old girl with standard-risk B-cell ALL who was in remission presented with sudden onset of left eye pain and loss of vision. Examination revealed no perception to light in the left eye with positive relative afferent pupillary defect. The optic disc was hyperemic and swollen with total obscuration of the disc margin associated with central retinal artery and vein occlusion. Magnetic resonance imaging of the brain and optic nerve showed left intraorbital optic nerve thickening associated with perineural enhancement and intraconal fat involvement. Lumbar puncture revealed leukemic infiltration with blast cells after a week of eye symptoms, while bone marrow aspiration was negative for malignant cells. A diagnosis of left leukemic optic nerve infiltration with central retinal artery and vein occlusion was made. A high index of suspicion with repeat cerebrospinal fluid sampling is crucial to confirm the diagnosis as vitreous biopsy may fail to reveal infiltrative cells.
A case of Acute Myeloid Leukemia masquerading as unilateral exudative detachment
American Journal of Ophthalmology Case Reports, 2016
Leukemias can involve almost every part of the human eye. Ophthalmic manifestations of leukemias can be divided into direct infiltration, secondary vascular changes and neuroophthalmological changes. Our case presented with exudative retinal detachment mimicking Vogt Koyanagi Harada's disease (VKH). Observations: A 30-years old Asian (Indian) female presented with insidious onset of painless diminution of vision from her right eye for one month. She gave history of fever and severe headache at the time of onset of ocular symptoms. Fundus examination revealed exudative retinal detachment at the posterior pole of her right eye. Fundus fluorescein angiography showed early stippled pin point hyperfluorescence, placoid pooling of the dye and late disc staining in both the eyes. A provisional diagnosis of Vogt Koyanagi Harada disease was made and routine blood investigations and a physician checkup for fitness for systemic steroids was done. Peripheral blood smear showed the presence of blast cells. The patient was diagnosed to have Acute Myeloid Leukemia (AML) and was started on chemotherapy. Conclusions and Importance: Acute myeloid leukemia can present as an exudative retinal detachment and can mimic similarly presenting conditions like VKH. Hence, this very important differential diagnosis should be kept in mind and it stresses the importance of simple laboratory investigations like whole and differential blood counts.
Hemorrhagic retinal detachment in acute promyelocytic leukemia
Taiwan Journal of Ophthalmology, 2013
A 14-year-old male had unilateral visual loss, bloodstained rhinorrhea, and generalized bruises with fever. Ocular echography of the right eye revealed unilateral hemorrhagic retinal detachment with internal echogenicity, and therefore, a hemorrhagic retinal detachment (oculus dexter). Peripheral blood smear tests revealed pancytopenia with 78% leukemic cells. Bone marrow sampling and genetic analysis established the diagnosis of acute promyelocytic leukemia. Hemorrhagic retinal detachment can be a presentation of acute promyelocytic leukemia, and thrombocytopenia and disseminated intravascular coagulation may be the etiologies. The combined bleeding diathesis is a challenging status for surgical management with poor visual prognosis.
Journal of Ophthalmic Inflammation and Infection, 2020
Purpose Acute macular neuroretinopathy (AMN) is a visual-deteriorating rare clinical entity with an uncertain etiology. We aimed to report a case of AMN and underlying disease of acute myeloid leukemia (AML). Case presentation A thirty-five-year-old female patient with bone marrow biopsy confirmed AML, and bicytopenia, under chemotherapy, complained of sudden paracentral visual field defect in her right eye was referred. Visual acuity was 20/20 in both eyes. Posterior segment evaluation revealed multiple Roth’s spots. Optical coherence tomography (OCT) demonstrated hyper-reflectivity band, in the outer nuclear layer and outer plexiform layer, nasal to the fovea of the right eye, and hyperreflective patch in outer retina segmentation en-face OCT, suggestive of the diagnosis of AMN. Nine days after AMN diagnosis, dyspnea, malaise, and cough was initiated. Ground glass opacities in lung CT scan, beside reverse transcription polymerase chain reaction of severe acute respiratory syndrome...
J Med Sci, 2005
We describe a 21-year-old patient with acute lymphoblastic leukemia (ALL) who achieved complete remission after induction, consolidation chemotherapy and central nervous system prophylaxis with intrathecal methotrexate and cranial irradiation. He developed a relapse of ALL 6 months after remission. This presented as isolated optic nerve infiltration with leukemic cells and sudden loss of ipsilateral vision prior to systemic relapse. Subsequent surgical intervention, salvage chemoradiotherapy and further allogeneic stem cell transplantation did not induce disease remission or restore his visual acuity.