Retinopathy as a Presenting Feature of Life-threatening Blood Cancer in a Young Male

Ocular involvement occurs in up to 90% of leukemia cases, but retinopathy as the initial manifestation of acute myeloid leukemia (AML) is uncommon and may indicate aggressive disease. Early recognition by ophthalmologists is crucial. A 36-year-old male presented with a sudden bilateral decrease in vision. Visual acuity was 0.4 in both eyes, and anterior segment findings were unremarkable. Dilated fundus examination revealed bilateral multiple Roth spots and blot hemorrhages, and cotton-wool spots throughout the posterior pole. The striking bilateral hemorrhagic retinopathy in the absence of systemic illness prompted urgent hematological evaluation. Complete blood count demonstrated severe anemia, thrombocytopenia, and marked leukocytosis with circulating blasts. Peripheral smear confirmed numerous myeloblasts. Bone marrow aspiration and immunophenotyping established a diagnosis of AML. The patient was started on induction chemotherapy, with ophthalmic follow-up planned to monitor the resolution of retinal hemorrhages. This case highlights that unexplained bilateral retinal hemorrhages with Roth spots and cotton-wool spots in a young adult should raise suspicion for underlying hematologic malignancy. Prompt ophthalmic recognition can facilitate early diagnosis and improve outcomes in AML.