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A 25-Year-Old Man with Exudative Retinal Detachments and Infiltrates without Hematological or Neurological Findings Found to Have Relapsed Precursor T-Cell Acute Lymphoblastic Leukemia.

Johnson JS, Lopez JS, Kavanaugh AS, Liang C, Mata DA - Case Rep Ophthalmol (2015)

Bottom Line: However, these findings are typically accompanied by the pathognomonic hematological signs of acute leukemia.In this case report and review of the literature, we describe a particularly unusual case of a 25-year-old man who presented to our hospital with bilateral exudative retinal detachments associated with posterior pole thickening without any hematological or neurological findings.Our case underscores the fact that the ophthalmologist may be the first provider to detect the relapse of previously treated leukemia, and that ophthalmic evaluation is critical for detecting malignant ocular infiltrates.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Louisiana State University Health Sciences Center, Shreveport, La, Boston, Mass., USA.

ABSTRACT

Background: Precursor T-cell acute lymphoblastic leukemia (pre-T-ALL) may cause ocular pathologies such as cotton-wool spots, retinal hemorrhage, and less commonly, retinal detachment or leukemic infiltration of the retina itself. However, these findings are typically accompanied by the pathognomonic hematological signs of acute leukemia.

Case presentation: In this case report and review of the literature, we describe a particularly unusual case of a 25-year-old man who presented to our hospital with bilateral exudative retinal detachments associated with posterior pole thickening without any hematological or neurological findings. The patient, who had a history of previously treated pre-T-ALL in complete remission, was found to have leukemia cell infiltration on retinal biopsy.

Conclusion: Our case underscores the fact that the ophthalmologist may be the first provider to detect the relapse of previously treated leukemia, and that ophthalmic evaluation is critical for detecting malignant ocular infiltrates.

No MeSH data available.


Related in: MedlinePlus

B-scan ultrasonography showing retinal detachment with significant thickening at the posterior poles.
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Figure 2: B-scan ultrasonography showing retinal detachment with significant thickening at the posterior poles.

Mentions: On physical examination, the patient had hand-motion vision in both eyes. Tonometric right- and left-eye pressures were 38 and 16 mm Hg, respectively. Pupils were sluggishly reactive without afferent pupillary defects. Upward gaze limitation with convergence/retraction-type nystagmus was present. Other gaze fields were normal. The eyelids, lashes, and lacrimal glands were normal on slit-lamp examination. The right-eye conjunctiva was diffusely injected, while that of the left eye was white and quiet. Corneas were clear. The right-eye anterior chamber had a grade 2 flare, while that of the left eye was deep and quiet. Irises were normal and lenses were clear. On dilated fundus examination, the right- and left-eye vitreous were hazy and clear, respectively. Bilateral diffuse intraretinal hemorrhages with whitening and complete bilateral retinal detachments without identifiable tears were seen (fig. 1). Retinal folds and areas of bullous detachment were noted. Nerves were difficult to visualize. B-scan ultrasonography confirmed these findings and revealed significant retinal thickening at the posterior poles (fig. 2).


A 25-Year-Old Man with Exudative Retinal Detachments and Infiltrates without Hematological or Neurological Findings Found to Have Relapsed Precursor T-Cell Acute Lymphoblastic Leukemia.

Johnson JS, Lopez JS, Kavanaugh AS, Liang C, Mata DA - Case Rep Ophthalmol (2015)

B-scan ultrasonography showing retinal detachment with significant thickening at the posterior poles.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608654&req=5

Figure 2: B-scan ultrasonography showing retinal detachment with significant thickening at the posterior poles.
Mentions: On physical examination, the patient had hand-motion vision in both eyes. Tonometric right- and left-eye pressures were 38 and 16 mm Hg, respectively. Pupils were sluggishly reactive without afferent pupillary defects. Upward gaze limitation with convergence/retraction-type nystagmus was present. Other gaze fields were normal. The eyelids, lashes, and lacrimal glands were normal on slit-lamp examination. The right-eye conjunctiva was diffusely injected, while that of the left eye was white and quiet. Corneas were clear. The right-eye anterior chamber had a grade 2 flare, while that of the left eye was deep and quiet. Irises were normal and lenses were clear. On dilated fundus examination, the right- and left-eye vitreous were hazy and clear, respectively. Bilateral diffuse intraretinal hemorrhages with whitening and complete bilateral retinal detachments without identifiable tears were seen (fig. 1). Retinal folds and areas of bullous detachment were noted. Nerves were difficult to visualize. B-scan ultrasonography confirmed these findings and revealed significant retinal thickening at the posterior poles (fig. 2).

Bottom Line: However, these findings are typically accompanied by the pathognomonic hematological signs of acute leukemia.In this case report and review of the literature, we describe a particularly unusual case of a 25-year-old man who presented to our hospital with bilateral exudative retinal detachments associated with posterior pole thickening without any hematological or neurological findings.Our case underscores the fact that the ophthalmologist may be the first provider to detect the relapse of previously treated leukemia, and that ophthalmic evaluation is critical for detecting malignant ocular infiltrates.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Louisiana State University Health Sciences Center, Shreveport, La, Boston, Mass., USA.

ABSTRACT

Background: Precursor T-cell acute lymphoblastic leukemia (pre-T-ALL) may cause ocular pathologies such as cotton-wool spots, retinal hemorrhage, and less commonly, retinal detachment or leukemic infiltration of the retina itself. However, these findings are typically accompanied by the pathognomonic hematological signs of acute leukemia.

Case presentation: In this case report and review of the literature, we describe a particularly unusual case of a 25-year-old man who presented to our hospital with bilateral exudative retinal detachments associated with posterior pole thickening without any hematological or neurological findings. The patient, who had a history of previously treated pre-T-ALL in complete remission, was found to have leukemia cell infiltration on retinal biopsy.

Conclusion: Our case underscores the fact that the ophthalmologist may be the first provider to detect the relapse of previously treated leukemia, and that ophthalmic evaluation is critical for detecting malignant ocular infiltrates.

No MeSH data available.


Related in: MedlinePlus