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Acute lymphoblastic leukemia relapse presenting with optic nerve infiltration.

Gianluca Dini1, Ilaria Capolsini2, Carla Cerri2

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|May 30, 2023
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Isolated ocular relapse in T-cell acute lymphoblastic leukemia is rare but serious. Prompt treatment with chemotherapy, radiation, and bone marrow transplant improved vision in a pediatric patient with optic nerve infiltration.

Keywords:
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Area of Science:

  • Pediatric Oncology
  • Ophthalmology
  • Neurology

Background:

  • Acute lymphoblastic leukemia (ALL) is the most common childhood cancer.
  • Despite treatment advances, 15%-20% of children with ALL experience relapse.
  • Isolated ocular relapse, particularly optic nerve infiltration, is uncommon.

Observation:

  • A 14-year-old male with T-cell ALL in remission presented with acute right eye pain and decreased vision.
  • Ophthalmoscopy and MRI confirmed optic nerve infiltration.
  • This presentation constitutes an ophthalmic emergency.

Findings:

  • The patient received salvage chemotherapy, orbital radiation, and bone marrow transplantation.
  • Treatment resulted in significant visual improvement.
  • Retinal and optic nerve findings regressed post-treatment.

Implications:

  • Optic nerve infiltration in pediatric ALL requires urgent, multidisciplinary management.
  • Radiation therapy can be a valuable addition to chemotherapy for achieving remission.
  • Early recognition and intervention are crucial for preserving vision in ocular ALL relapse.