Proptosis in a Patient With Known Graft Versus Host Disease

Area of Science:

• Ophthalmology
• Hematology
• Oncology

Background:

• A patient with acute myeloid leukemia (AML) underwent bone marrow transplant and developed graft-versus-host disease (GVHD).
• Ocular symptoms, including irritation and injection, were noted.
• Insidious onset of proptosis, binocular diplopia, and extraocular motility limitation occurred.

Observation:

• Magnetic Resonance Imaging (MRI) revealed significant enlargement of extraocular muscles.
• Bone marrow aspiration confirmed a relapse of leukemia.

Findings:

• Chemotherapy led to marked improvement in proptosis and extraocular motility.
• Proptosis and extraocular motility limitation are uncommon in GVHD.

Implications:

• Ocular findings in GVHD patients require careful evaluation beyond typical irritation.
• Proptosis and motility issues in GVHD warrant orbital imaging to exclude malignancy recurrence.
• This case underscores the importance of ophthalmologic assessment in patients with a history of malignancy.