[Ocular relapse of acute lymphoblastic leukemia]

Area of Science:

• Ophthalmology
• Pediatric Oncology
• Hematology

Background:

• Leukemic hypopyon, an accumulation of leukemic cells in the anterior chamber, can be an initial presentation or a sign of relapse in pediatric leukemia.
• Acute lymphoblastic leukemia (ALL) is the most common childhood cancer, and ocular involvement requires prompt recognition and management.

Observation:

• A 5-year-old child with a history of acute lymphoblastic leukemia presented with bilateral leukemic hypopyon 30 months after completing treatment.
• Anterior chamber paracentesis confirmed the presence of leukemic cells, establishing the diagnosis of an ocular relapse.

Findings:

• The ocular relapse was treated with topical corticosteroids, chemotherapy, and radiotherapy.
• Despite treatment, the child experienced a medullar relapse 16 months later and unfortunately died.

Implications:

• This case highlights the importance of considering leukemic relapse in pediatric patients presenting with hypopyon, even years after initial treatment.
• Early detection and multimodal treatment strategies are essential for managing ocular leukemia relapses, but long-term prognosis remains challenging.
• Understanding the clinical spectrum and therapeutic options for leukemic invasion of the anterior segment is critical for improving patient outcomes.