Diplopia as the presenting feature of acute lymphoblastic leukemia
A T Burshina1, Rajasekar Thirugnanam2, Arul Selvan3
1Neuro Ophthalmology Department, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, Tamilnadu, India.
Purpose:
To report a rare case of acute lymphoblastic leukemia presenting with diplopia to an ophthalmologist.
Observations:
A 29-year-old male patient presented to ophthalmology department with sudden onset of binocular diplopia in left gaze. Magnetic resonance imaging of brain and orbits revealed a thickened left medial rectus, with enhancement of right sixth nerve, bilateral third and fifth nerves. Bone marrow biopsy revealed acute lymphoblastic leukemia (ALL) with a Burkitt-type chromosomal translocation-t(8; 14) and the patient was started on chemotherapy.
Conclusion And Importance:
This was a case of incomitant esotropia worse with left gaze due to left medial rectus infiltration mimicking a left sixth cranial nerve paresis. Diplopia can be the only presenting symptom of ALL and it can involve either an extraocular muscle or a cranial nerve.
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