Macular Hemorrhage as the First Manifestation of Leukemia

Acute lymphoblastic leukemia (ALL) is a malignant neoplasm of the blood and bone marrow characterized by the uncontrolled proliferation of precursor cells of B- or T-lymphocyte lineage. Usually, the disease arises because of spontaneous mutations in bone marrow cells. Risk factors include genetic predisposition, exposure to ionizing radiation, prior chemotherapy or radiotherapy, and certain environmental factors. Clinical manifestations may include recurrent infections, anemia, and an increased tendency toward bleeding and stroke. A 12-year-old boy presented to the emergency department with a sudden decrease in visual acuity in the right eye. Best-corrected visual acuity (BCVA) in the right eye was 0.02, and intraocular pressure (IOP) was 16 mmHg. Ophthalmologic examination revealed a macular hemorrhage in the right eye. Blood samples were obtained for laboratory analysis. Complete blood count demonstrated leukocytosis with a white blood cell (WBC) count of 362.58 × 10³/µL, thrombocytopenia with a platelet (PLT) count of 87 × 10³/µL, hemoglobin (Hgb) level of 8.7 g/dL, and a red blood cell (RBC) count of 3.46 × 10⁶/µL. The patient was subsequently referred to the Department of Pediatric Hematology, where the diagnosis of acute lymphoblastic leukemia of B-cell precursor origin was confirmed. Appropriate systemic therapy targeting the underlying disease was initiated.