Unilateral infiltration of the optic nerve revealing relapse of an acute lymphoblastic leukemia

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Published Sep 3, 2019
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Vol. 97 No. 3 (2019): Issue Mar 2019

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Mejda Bouladi
Rim Bouraoui
Noura Zerei
Leila El Matri

Abstract

INTRODUCTION:
Ocular infiltration of leukemia can involve orbit, uveal tract, retina and optic nerve. It may result from direct ocular infiltration by leukemic cells or indirect ocular involvement resulting from secondary hematologic changes, opportunistic infections and complications of various modalities of therapy.
We report a case of unilateral infiltration of the optic nerve revealing a relapse of acute lymphoblastic leukemia.
Case report:
forty eight years-old woman in a remission of acute B lymphoblastic leukemia presented with headaches and blurred vision in the left eye. Ophthalmic examination showed a visual acuity reduced to 20/200 in the left eye, and a voluminous disc edema with papillary mass surrounded by retinal hemorrhages, exudates and important serous retinal detachment. CT scan showed a thickened left optic nerve and excluded true papillary edema due to intracranial hypertension secondary to central nervous system involvement. Myelogram and lumbar punction demonstrated blast infiltration and confirmed ocular relapse of the leukemia.
Conclusion:
The incidence of ocular involvement lymphoblastic acute leukemias decreased since the introduction of a systematic prophylactic treatment of central nervous system. Periodic ophthalmic examination is necessary to allow early diagnosis and treatment. 

Keywords:

acute lymphoblastic leukemia, ocular involvement, optic nerve infiltration

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References

  1. Nikaido H, Mishima H, Ono H, Choshi K, Dohy H. Leukemic involvement of the optic nerve. Am J Ophthalmol.1988;105:294-8.
  2. Sharma T, Grewal J, Gupta S, Murray PI. Ophthalmic manifestations of acute leukemias: The Ophthalmologist's role. Eye.2004;18:663-72.
  3. Leukemic Optic Nerve Infiltration. Randhawa S, Ruben J. Ophthalmology. 2017;124(3):277.
  4. Gordon KB, Rugo HS, Duncan JL, Irvine AR, Howes EL, O'Brein JM, et al. Ocular Manifestations of leukemia: Leukemic infiltration versus infectious process. Ophthalmology.2001;108:2293-300.
  5. Acute Lymphoblastic Leukemia Relapse Presenting as Optic Nerve Infiltration. Wong BJ, Berry JL. JAMA Ophthalmol. 2017;12;135(1):e164656.
  6. Asymptomatic Leukemic Optic Nerve Infiltration as Presentation of Acute Lymphoblastic Leukemia Relapse. Caty J, Grigorian AP, Grigorian F. J Pediatr Ophthalmol Strabismus. 2017;9;54:e60-e62.
  7. Eze BI, Ibegbulam GO, Ocheni S. Ophthalmic manifestations of leukemia in a tertiary hospital population of adult Nigerian Africans. Middle East Afr J Ophthalmol.2010 Oct;17(4):325-9.
  8. Schachat AP, Markowitz JA, Guyer DR, Burke PJ, Karpe JA, Graham ML. Ophthalmic manifestations of Leukemia. Arch Ophthalmol.1989;107:697-700.
  9. Kincaid M, Green W. Ocular and orbital involvement in leukemia. Surv Ophthalmol.1983;27:211-32.
  10. Lin YC, Wang AG, Yen MY, Hsu WM. Leukaemic infiltration of the optic nerve as the initial manifestation of leukaemic relapse. Eye.2004;18(5):546-50.
  11. Siedlińska M, Karska-Basta I, Pagacz D, Sobociński M, Romanowska-Dixon B. Ocular manifestations of acute T-cell lymphoblastic leukemia in hematological remission- a case report. Klin Oczna.2014;116(3):184-6.
  12. Chocron IM, Morrison DG, Friedman DL, Desai NA, Donahue SP. Ophthalmic manifestations of relapsing acute childhood leukemia. J AAPOS.2015;19(3):284-6.