[Retinopathy as the first symptom of hairy cell leukemia]

Hairy cell leukemia is a seldom non-Hodgkin-lymphoma of the B-cells. The case of a 39 year old male with loss of vision as first sign of hairy cell leukemia is presented. The decrease of vision was caused by intraretinal bleeding into the macula. By means of ophthalmoscopy and angiography we found intraretinal bleedings, soft exudates, microaneurysms and capillary occlusions. The examination of blood cells showed leucocytosis (48.900/microliter), anemia (hemoglobin 8.7 g/l), thrombocytopenia (67.000/microliter) and hairy cells in peripheral blood and in bone marrow. Under treatment with alpha-Interferon visual acuity became normal and the fundus lesions decreased. This case points out that a retinopathy with bleedings and soft exudates can be caused by leukemia which should therefore be excluded by differential blood count.