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Acute lymphocytic leukemia masquerading as acute retinal necrosis
Kaylene L Carter1, Muhammad Hassan1, Diana V Do1
1Byers Eye Institute at Stanford University, 2370 Watson Court Suite 200, Palo Alto, CA, 94303, United States.
American Journal of Ophthalmology Case Reports
|April 8, 2020
Summary
This case study details a rare instance of B-cell acute lymphocytic leukemia (ALL) relapse manifesting as acute retinal necrosis. Early diagnosis and treatment led to vision improvement and retinal healing.
Area of Science:
- Ophthalmology
- Hematology
- Oncology
Background:
- Acute lymphocytic leukemia (ALL) is a cancer of the blood and bone marrow.
- Relapse of B-cell ALL can present with unusual extra-osseous manifestations.
- Ocular involvement in leukemia relapse is uncommon but critical to recognize.
Observation:
- An 11-year-old boy with B-cell ALL experienced vision loss and eye pain.
- Ophthalmic examination revealed signs of acute retinal necrosis, including retinal whitening and detachment.
- Lumbar puncture and bone marrow biopsy confirmed leukemia relapse.
Findings:
- Vitreous biopsy identified atypical lymphoblasts, confirming intraocular leukemia.
- Treatment included chemotherapy, orbital radiation, and systemic prednisone.
- The patient showed improved visual acuity, reduced hemorrhages, and resolved retinal detachment.
Implications:
- This case highlights acute retinal necrosis as a rare presenting sign of B-cell ALL relapse.
- It underscores the importance of ophthalmologic evaluations in patients with leukemia remission.
- Prompt diagnosis and multidisciplinary treatment are crucial for managing ocular leukemia involvement.
