ACUTE VISION LOSS AS THE ONLY SIGN OF LEUKEMIA RELAPSE.

Area of Science:

• Hematology
• Ophthalmology
• Oncology

Background:

• Acute lymphoblastic leukemia (ALL) is a significant hematologic malignancy.
• Relapse of ALL can present with diverse clinical manifestations.
• Maintaining remission and early detection of relapse are critical for patient outcomes.

Observation:

• A 35-year-old male patient, previously treated for high-risk B-type ALL, presented with unilateral vision loss.
• Ophthalmologic examination revealed exudative retinal detachment as the primary clinical sign.
• Hematologic, cerebrospinal fluid, and bone marrow evaluations showed no overt signs of disease recurrence.

Findings:

• Transvitreal retinochoroidal cytology confirmed leukemic B-cell infiltration with a t(12:21) translocation.
• This ocular finding was the sole indicator of B-type ALL relapse.
• The patient had been in complete remission for three years prior to this presentation.

Implications:

• Ocular symptoms, such as vision loss, may be the earliest sign of ALL relapse.
• Ophthalmologic evaluation and ocular biopsy are crucial for diagnosing isolated leukemia relapse, irrespective of systemic findings.
• Prompt diagnosis through comprehensive ocular assessment can significantly improve survival rates in relapsed ALL patients.