LEUKEMIC OPTIC NERVE INFILTRATION IN A PATIENT WITH ACUTE LYMPHOBLASTIC LEUKEMIA

To describe the clinical presentation and imaging features of a patient with acute lymphoblastic leukemia that was complicated by optic nerve leukemic infiltration.

A 36-year-old man with history of acute lymphoblastic leukemia on treatment presented with decreased vision and optic nerve leukemic infiltrates.

At presentation, ocular examination revealed decreased visual acuity at hand movement close to face in his right eye and 20/120 in his left eye. Fundus examination showed a pale optic disk with blurred margins and multiple flame-shaped and dot and blot retinal hemorrhages in his right eye and disk edema with whitish leukemic infiltrates over it with few dot and blot retinal hemorrhages in his left eye. The patient was referred to the treating oncologist, and curative orbital radiotherapy was administered. Vision improved dramatically to 20/40 in the right eye and to 20/20 in the left eye. He again reported with complaints of blurring of vision in the left eye after 1 month. Visual acuity was 20/20, but fundus revealed severe disk edema with whitish leukemic infiltrates. We diagnosed as relapse of leukemic optic nerve infiltration and referred to the treating oncologist for further management.

Isolated optic nerve relapse of leukemic infiltration is of paramount importance to early diagnosis, as vision can be saved if treatment is initiated promptly.