Leukemic retinophaty, the first manifestation in a case of acute myelogenous leukemia (original) (raw)
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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.
Leukemic retinopathy, a rare entity: A case report
Asian Journal of Medical Sciences, 2021
Chronic myelogenous leukemia (CML), also known as chronic myeloid leukemia, is a myeloproliferative disorder characterized by increased proliferation of the granulocytic cell line without the loss of their capacity to differentiate. Consequently, the peripheral blood cell profile shows an increased number of granulocytes and their immature precursors, including occasional blast cells. CML accounts for 20% of all leukemias affecting adults. Retinal lesions are the most common ocular manifestation of leukemia. They are found most often in adults and in patients with myeloid leukemia. Despite the significant efforts made by different groups to optimize treatment and outcome, there are still unmet needs and unanswered questions. Ophthalmologic manifestations are among the therapeutic challenge. Here we present a case of CML (chronic phase) with ophthalmologic manifestations as initial presentation, trying to shed light on this important type of presentation.
Flaming Retinal Hemorrhage Revealing Acute Lymphoblastic Leukemia ( About a Case )
2019
The frequency of retinal damage in acute leukemias can range from 28 to 50%. These retinal lesions may be indicative of leukemia. A 51-year-old patient consults for a sharp decrease in bilateral visual acuity and in whom fundus examination shows the presence of multiple retinal hemorrhages disseminated at the posterior pole in both eyes and that some of them are white-centered the rest of the somatic examination is without abnormality. The etiological diagnosis makes it possible to link them to a table of acute lymphoblastic leukemia so that the patient was treated in collaboration with the oncologist. In the medical literature, several cases of retinal hemorrhages are reported as manifestations of acute leukaemias. They are exceptional as the mode of entry of the disease. Finally, from this observation, we show the interest of ophthalmological examination in the case of leukemia both for diagnosis and treatment.
A case of leukemic retinopathy mimicking common ischemic retinopathies
Clinical Case Reports, 2015
Reported case of leukemic retinopathy mimicking common ischemic retinopathies in a young adult where ophthalmic visit was the first step to the diagnosis of chronic myeloid leukemia. It highlights the importance of routine eye exams and that clinicians should suspect leukemia in an otherwise healthy patient presenting with ischemic retinopathy.
Ophthalmic Manifestations of Newly Diagnosed Acute Leukemia Patients in a Tunisian Cohort
Clinical Ophthalmology
To describe ocular manifestations of acute leukemia in a Tunisian cohort and to assess the associations between ophthalmic findings and epidemiological, clinical, and biological features of the disease. Methods: A prospective study included patients newly diagnosed with acute leukemia referred to our clinics between January 2019 and July 2020. All patients underwent a complete ophthalmic evaluation and spectral-domain optical coherence tomography (SD-OCT) at presentation, then every two months during one year. We defined two groups: Group 1 included patients with leukemic ophthalmopathy and group 2 included patients with normal ophthalmic examination. Results: Forty-six patients were enrolled. The mean age of patients was 32.1±15.3 years. The sex ratio M/F was 1.55 (28 male patients and 18 females). Twenty-nine patients (63%) had acute myeloid leukemia (AML), and 17 (37%) had acute lymphoblastic leukemia (ALL). The average follow-up was 9.1 months (range: 3-12 months). We observed ophthalmic manifestations in 28 patients (61%). Among them, 17 (61%) had vision-threatening complications. The posterior segment was the most common site of ocular involvement (82% of group1). Primary leukemic infiltration (Disc edema, ptosis, exophthalmos) was present in 13 eyes (14.1%). Twenty-seven eyes (29.3%) had secondary involvement lesions (Subconjunctival hemorrhage, periorbital ecchymosis, retinal/subhyaloid hemorrhage, dilated/tortuous veins). Twenty-one eyes (22.8%) showed other ocular manifestations which etiopathogenesis is not yet fully understood (White-centred hemorrhages, cotton-wool spots, serous retinal detachment, hemorrhagic pigment epithelial detachment). Leukemic retinopathy was significantly more frequent in adults (23/39 and 1/7 in adult and pediatric groups, respectively; p=0.003). Patients suffering from AML were more likely to have secondary ocular involvement (20/29 and 7/17 in AML and ALL patients, respectively; p=0.047). Retinal hemorrhages were statistically associated with anemia and thrombocytopenia (p=0.041 and p=0.034; respectively). Conclusion: Leukemic ophthalmopathy seems to be frequent and may lead to severe visual impairment. An ophthalmic assessment complemented with SD-OCT has paramount importance in all newly diagnosed acute leukemic patients.
International Journal of Public Health and Clinical Sciences, 2019
Background: Acute lymphoblastic leukaemia (ALL) is the commonest childhood malignancy and ocular manifestations are uncommon in ALL. Patients may present with non-specific systemic symptoms which are overlooked and life threatening symptoms of leukostasis often present late. Here, we present a rare case of ALL where ocular symptoms preceded constitutional symptoms. Materials and Methods: A case report. Result: A 11-year-old girl presented with a syncopal attack during the fasting month to a primary health center. She was investigated at a tertiary center and diagnosed to have ALL. Further history revealed she had sudden painless severe reduced vision in the right for one month prior to this. Ocular assessment noted her right visual acuity was 5/60 and left visual acuity was 6/6. Her right fundus had a large subhyaloid haemorrhage over the macula and multiple large white-centered haemorrhages (Roth's spot); while the left fundus showed multiple large Roth's spots and some intraretinal haemorrhages. Chemotherapy was instituted after immunophenotyping was reported as precursor B-cell ALL. Ocular condition was managed conservatively. There was total resolution of the subhyaloid haemorrhage and retinal haemorrhages in both eyes and she regained full vision bilaterally while on induction therapy over 5 months. Conclusion: Life threatening conditions such as ALL should be considered in children with sudden, painless, reduced vision and urgent ophthalmology assessment is important for early detection. Blurry vision could be the earliest symptom in ALL. Awareness on eye health must be emphasized in school by the educators for early detection of both sight and life threatening condition among children.
Cureus, 2021
Background: Leukemia is a neoplastic disorder that affects blood and bone marrow and is characterized by white blood cells' abnormal proliferation. Leukemia patients may present with different ophthalmic manifestations. This study aims to provide an updated data about the prevalence and types of ocular manifestations in acute leukemia patients and their relation with the hematological parameters. Methods: This retrospective cross-sectional study included all acute leukemia patients diagnosed from 2015 to 2020 and underwent an ophthalmic examination during this period at King Abdulaziz Medical City in Jeddah. Results: Eighty-one patients met the inclusion and exclusion criteria and had ophthalmic examinations. Forty-three (53.1%) patients were males, and 38 (46.9%) patients were females. Acute lymphocytic leukemia (ALL) was diagnosed in 55 (67.9%) patients, while acute myelogenous leukemia (AML) was diagnosed only in 26 (32.1%). Ophthalmic manifestations were observed in 23 patients with a prevalence of 28.4%. AML patients had more manifestations with a rate of 38.5%. ALL had a rate of 23.6% (p=0.1). Retinal hemorrhage was the most commonly seen manifestation in six patients. Conclusion: Ophthalmic manifestations are not uncommon in acute leukemia patients. Low hemoglobin and RBC could give an idea about the type of ophthalmic manifestation, not the presence or absence. It is highly recommended to examine acute leukemia patients routinely prior, during, and after the treatment to prevent serious ocular damage and monitor the course of the disease.
Journal of Clinical & Experimental Ophthalmology, 2017
The leukemias are malignant neoplasms of the hematopoietic stem cells, characterized by diffuse replacement of the bone marrow by neoplastic cells. There are 3 stages in Chronic Myeloid Leukemia-chronic phase, accelerated phase and blast phase. Ophthalmic manifestation can be classified into two categories: primary or direct leukemic infiltration and secondary or indirect involvement. Screening for ocular manifestations of leukemia, although not a routine practice, is important as they may antedate systemic disease or form an isolated focus of its relapse. The prevalence of ocular involvement in leukemic patients has been reported to be 9% to 90% in various studies. To highlight the important ophthalmic manifestation in patients of leukemias we are presenting a case report on chronic myeloid leukemia in accelerated phase of a young male patient referred from medicine OPD with chief complaints of blurring of vision in both eyes since 2 days.
Ophthalmological Manifestations in Acute Lymphoblastic Leukemia
InTech eBooks, 2011
The aim of the present chapter is to review the different ophthalmological signs and symptoms that can be observed in acute lymphoblastic leukemia and the importance of the examination of these patients by an ophthalmologist whenever an ocular affectation is suspected. Acute lymphoblastic leukemia is a malignant neoplasm caused by the proliferation of poorly differenciated precursors of the lymphoid cells, which are known as blast cells. Blast cells replace the normal elements of the bone marrow, decreasing the production of normal blood cells and, therefore, causing anemia, thrombocytopenia and neutropenia. They can also infiltrate other organs, such as liver, spleen, lymph nodes or, less frequently, central nervous system. (Florensa et al, 2006; Ribera & Ortega, 2003; Sharma et al, 2004) Acute lymphoblastic leukemia is the most common type of leukemia in children, although it is also seen in adult patients. If blood test results are abnormal or the doctor suspects leukemia despite normal cell counts, a bone marrow aspiration and biopsy are the next steps. Treatment is based on chemotherapy, radiotherapy and bone marrow transplantation.