Serous retinal detachment as a presenting sign of acute lymphoblastic leukemia: A case report and literature review

American Journal of Ophthalmology Case Reports

Natalia F. Callaway¹  Quan Dong Nguyen¹  Malini Veerappan Pasricha¹  Diana V. Do² 

[1] Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA, 94303, USA;Corresponding author. Byers Eye Institute, Stanford University Medical Center, 2452 Watson Court, Palo Alto, CA, 94303, USA.;

关键词: Acute lymphoblastic leukemia;    Acute lymphoid leukemia;    Acute lymphocytic leukemia;    Serous retinal detachment;    Exudative retinal detachment;    Central serous chorioretinopathy;   

DOI  :  

来源: DOAJ

【 摘 要 】

Purpose: To describe a unique case of unilateral serous retinal detachment as the presenting sign of B-cell acute lymphoblastic leukemia (ALL). Observations: A 74 year old woman presented with right eye blurry vision and was found to have an underlying serous retinal detachment, along with cotton wool spots, inner retinal hemorrhages, and retinal pigment epithelial changes throughout her bilateral fundi. Fluorescein angiography demonstrated bilateral vasculitis and ultrasonography revealed asymmetric thickening and enhancement of the affected eyes’ choroid. This prompted a systemic lab workup and results were suspicious for an underlying hematologic malignancy. The patient was admitted to the hospital for bone marrow biopsy confirming B-cell ALL, underwent intensive intravenous and intrathecal chemotherapy, and was discharged one month later. Follow up appointment in the ophthalmology clinic demonstrated functional and anatomic improvement in the serous retinal detachment and choroidal thickening suggestive of infiltration in her right eye. Conclusions: SRDs are an uncommon ocular manifestation of leukemia, and even less common as a presenting sign of the disease. A comprehensive literature review demonstrated 11 other cases reported worldwide. We present the first such case with additional findings of leukemic retinopathy, optic nerve and choroidal infiltration, and vasculitis, as well as a complete library of ophthalmic imaging from the patient's initial presentation. Importance: A new diagnosis of serous retinal detachment(s) without any obvious cause should raise suspicion for leukemia and prompt further workup. Early recognition of this hematologic malignancy is crucial for prompt initiation of life-saving therapy.

【 授权许可】

Unknown