Isolated Anterior Segment Relapse in a Child With B-Cell Precursor Acute Lymphoblastic Leukemia: A Rare Case Report

Area of Science:

• Pediatric Oncology
• Ophthalmology
• Hematology

Background:

• Ocular relapse in pediatric acute lymphoblastic leukemia (ALL) is uncommon.
• Anterior segment infiltration as the sole relapse manifestation is exceptionally rare and can mimic noninfectious uveitis, causing diagnostic delays.

Purpose of the Study:

• To report a rare case of isolated anterior segment relapse in pediatric ALL.
• To emphasize the importance of considering ocular involvement in leukemia survivors with atypical uveitis.

Main Methods:

• Case report of a 4-year-old boy with B-cell precursor ALL.
• Clinical examination including slit-lamp and ultrasound biomicroscopy.
• Systemic reevaluation for hematologic and central nervous system relapse.

Main Results:

• The patient presented with isolated anterior segment inflammation mimicking uveitis.
• Ocular findings preceded confirmed hematologic relapse by approximately 3 months.
• Relapse was confirmed with significant circulating blasts and bone marrow involvement.

Conclusions:

• Anterior segment infiltration can be the initial manifestation of relapse in pediatric ALL.
• High suspicion for ocular involvement is crucial in leukemia survivors with persistent or atypical uveitis.
• Early recognition of ocular signs can facilitate timely diagnosis and treatment of systemic recurrence.