Ocular relapse in acute myeloid leukemia (M4) with normal bone marrow

Area of Science:

• Hematology
• Ophthalmology
• Oncology

Background:

• Acute myeloid leukemia (AML) M4 is a subtype of leukemia.
• Extramedullary relapse, particularly in the eye, is an uncommon complication of AML.
• Maintaining remission after initial treatment is crucial for patient outcomes.

Observation:

• A 47-year-old woman with AML M4 achieved remission after chemotherapy.
• Four months post-treatment, she developed ocular symptoms including pain, redness, and a mass in the left eye.
• Biopsy confirmed diffuse blast cell infiltration in the ocular lesion, with concurrent bone marrow remission.

Findings:

• The ocular relapse involved the subconjunctival space, anterior chamber, and likely the lacrimal gland of the left eye.
• Subcutaneous nodules were also present on her forearms.
• Histopathology revealed blast cell infiltration consistent with leukemia.

Implications:

• Ocular extramedullary relapse in AML M4, though rare, can precede bone marrow recurrence.
• This presentation suggests a grave prognosis, even with intensive chemotherapy.
• Early detection and understanding of extramedullary relapse patterns are vital for managing AML patients.