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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

Retinal biopsy specimen (×400) stained with hematoxylin and eosin (a) and CD3 (b).
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Figure 4: Retinal biopsy specimen (×400) stained with hematoxylin and eosin (a) and CD3 (b).

Mentions: Because the patient was not improving on antivirals, retinal biopsy was performed. As on dilated fundus examination, no tears were identified, and a diagnosis of bilateral exudative retinal detachment was confirmed. The patient underwent left-eye retinal detachment repair with biopsy. Pathologic analysis of the retinal biopsy, including molecular, cytogenetic, and flow cytometric testing, revealed infiltration with pre-T-ALL (fig. 4). This finding was confirmed on left-eye vitreal and subretinal fluid cytology. The patient was referred to his hematologist for further treatment with radiation therapy to both eyes, systemic chemotherapy, and bone-marrow transplant. The patient's exudative detachment and optic nerve symptoms improved. The right-eye intraocular pressure corrected, and the left-eye retina remained flat. Nonetheless, his visual acuity remained poor in both eyes, with light perception vision.


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)

Retinal biopsy specimen (×400) stained with hematoxylin and eosin (a) and CD3 (b).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Retinal biopsy specimen (×400) stained with hematoxylin and eosin (a) and CD3 (b).
Mentions: Because the patient was not improving on antivirals, retinal biopsy was performed. As on dilated fundus examination, no tears were identified, and a diagnosis of bilateral exudative retinal detachment was confirmed. The patient underwent left-eye retinal detachment repair with biopsy. Pathologic analysis of the retinal biopsy, including molecular, cytogenetic, and flow cytometric testing, revealed infiltration with pre-T-ALL (fig. 4). This finding was confirmed on left-eye vitreal and subretinal fluid cytology. The patient was referred to his hematologist for further treatment with radiation therapy to both eyes, systemic chemotherapy, and bone-marrow transplant. The patient's exudative detachment and optic nerve symptoms improved. The right-eye intraocular pressure corrected, and the left-eye retina remained flat. Nonetheless, his visual acuity remained poor in both eyes, with light perception vision.

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