A case of aggressive natural killer cell leukemia

A 23-year-old man presented with a 1-month history of a red and painful right eye, with visual acuity reduced to hand motions. Examination showed uveitis with keratic precipitates, cells and flare in the anterior chamber, and vitritis that obscured visualization of the right fundus. The following week, he was noted to have the following left-sided findings: reduced visual acuity (6/18), painless upper eyelid edema, an elevated, pink bulbar conjunctival lesion, limitation of ocular abduction, paresthesia in the V1 and reduced sensation in the V2 distributions. Blood tests showed pancytopenia. Results from the aspirate and trephine biopsy of his bone marrow were consistent with aggressive natural killer (NK) cell leukemia, a rare cause of ocular and periocular inflammation that requires a multidisciplinary team approach to care.