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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

Axial magnetic resonance imaging showing intraocular hyperintensities of the posterior pole consistent with retinal infiltrate and subretinal exudative fluid.
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Figure 3: Axial magnetic resonance imaging showing intraocular hyperintensities of the posterior pole consistent with retinal infiltrate and subretinal exudative fluid.

Mentions: The patient was admitted and started on intravenous acyclovir to cover for possible acute retinal necrosis versus progressive outer retinal necrosis. As the initial complete blood count was normal, there was less concern for cytomegalovirus retinitis. The patient was started on dorzolamide/timolol for his increased right intraocular pressure. Given his upward gaze palsy, he underwent magnetic resonance imaging to assess for possible central nervous system involvement, which showed only soft-tissue masses consistent with subretinal exudative fluid (fig. 3). Lumbar puncture was normal. Right-eye vitreal biopsy polymerase chain reaction was negative for herpes simplex, varicella zoster, cytomegalovirus, and toxoplasmosis, and cytology was negative for malignancy.


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)

Axial magnetic resonance imaging showing intraocular hyperintensities of the posterior pole consistent with retinal infiltrate and subretinal exudative fluid.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Axial magnetic resonance imaging showing intraocular hyperintensities of the posterior pole consistent with retinal infiltrate and subretinal exudative fluid.
Mentions: The patient was admitted and started on intravenous acyclovir to cover for possible acute retinal necrosis versus progressive outer retinal necrosis. As the initial complete blood count was normal, there was less concern for cytomegalovirus retinitis. The patient was started on dorzolamide/timolol for his increased right intraocular pressure. Given his upward gaze palsy, he underwent magnetic resonance imaging to assess for possible central nervous system involvement, which showed only soft-tissue masses consistent with subretinal exudative fluid (fig. 3). Lumbar puncture was normal. Right-eye vitreal biopsy polymerase chain reaction was negative for herpes simplex, varicella zoster, cytomegalovirus, and toxoplasmosis, and cytology was negative for malignancy.

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