Acute lymphoblastic leukemia presenting with bilateral serous macular detachment

Vieira, Lina; Silva, Nuno Aguiar; Dutra-Medeiros, Marco; Flores, Rita; Maduro, Vitor

doi:10.5935/0004-2749.20150101

Cited by 12 publications

(5 citation statements)

References 4 publications

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“…Of the cases of ophthalmic DS described so far, there has been a predilection for disease to affect the choroidal and retinal tissues as has been seen in patients with ocular leukaemia, with a pattern of chorioretinopathy which is clinically similar to Vogt-Koyanagi-Harada disease. 21 , 23 , 24 , 28 , 29 , 30 , 31 Notably absent in the three described cases of ophthalmic DS however have been the findings of vitritis, sterile hypopyon, keratic precipitates, retinal vasculitis, vascular sheathing, retinal vascular congestion, choroidals, or orbital involvement. In this series, the retinopathy has been limited to intra-retinal and superficial retinal haemorrhages, with one patient presenting with a unilateral Roth's spot, however both patients had concurrent thrombocytopaenia.…”

Section: Discussionmentioning

confidence: 85%

“…The differential diagnoses considered for the ocular appearances above include the differentiation syndrome, leukaemic infiltration, hypoproteinaemia, central serous chorioretinopathy secondary to steroid use, the multifocal inflammatory chorioretinopathies, choroiditis, choroidal ischaemia secondary to intravascular coagulation, autoimmune uveitis, and posterior scleritis. 21 , 31 , 32 , 33 , 34 Focal endogenous endophthalmitis secondary to the Escherichia coli septicaemia in Case 2 was considered to be less likely as E. coli endophthalmitis is typically associated with poor visual prognosis. 35 , 36 , 37 , 38 , 39 , 40 A case of bilateral exudative retinal detachment secondary to E. coli septicaemia has been recently reported, however the pattern of chorioretinopathy and other ophthalmic manifestations were not in keeping presentation of the two above reported cases.…”

Section: Discussionmentioning

confidence: 99%

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Two cases of differentiation syndrome with ocular manifestations in patients with acute promyelocytic leukaemia treated with all-trans retinoic acid and arsenic trioxide

Newman

Leung

Richards

et al. 2018

American Journal of Ophthalmology Case Reports

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PurposeTo describe two cases of differentiation syndrome presenting with ocular manifestations including bilateral chorioretinopathy in patients with acute promyelocytic leukaemia treated with all-trans retinoic acid and arsenic trioxide differentiation therapy.ObservationsThis observational case series identifies two patients at a single tertiary institution diagnosed with differentiation syndrome with associated ophthalmic involvement. Both patients reported bilateral reduction in visual acuity at days fourteen and ten respectively following initiation of differentiation therapy in addition to developing other systemic manifestations of differentiation syndrome. Both patients received the same chemotherapeutic regimen including both all-trans retinoic acid and arsenic trioxide as well as ten days of routine differentiation syndrome prophylaxis with oral prednisolone. Case 1 presented with bilateral pale yellow sub-retinal lesions concentrated at the posterior poles with ocular coherence tomography (OCT) evidence of bilateral multifocal areas of focal RPE elevation and adhesion to the thickened outer retina with interspersed sub-retinal fluid. Fluorescein angiography revealed areas of early hyperflouresence corresponding to the yellow chorioretinal lesions with late diffuse leakage of fluid into the subretinal space. Case 2 presented with a similar characteristic retinal findings on fundoscopy and optical coherence tomography. Both patients experienced rapid improvement in the visual symptoms and marked resolution of the sub-retinal fluid within seven to fourteen days of onset with excellent long-term visual outcome. Both patients achieved molecular remission after induction and received standard consolidation and maintenance therapy without visual disturbance.Conclusion and importanceOcular manifestations of differentiation syndrome have been only recently recognised. We present a case series of two patients with differentiation syndrome with ocular involvement. Common to both presentations was the presence of bilateral reduction in visual acuity with multifocal serous retinal detachment secondary to chorioretinopathy. The visual outcome from both presentations was excellent with rapid normalisation of visual acuity and resolution of the sub-retinal fluid with only the first case having their differentiation therapy temporarily withheld during the acute phase of illness.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Two cases of differentiation syndrome with ocular manifestations in patients with acute promyelocytic leukaemia treated with all-trans retinoic acid and arsenic trioxide

Newman

Leung

Richards

et al. 2018

American Journal of Ophthalmology Case Reports

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“…In addition, leukemia-related hyperfluorescent pinpoints in the posterior retina were described by Vieira et al. 22 These hyperfluorescent pinpoints were presumed to be constituted of the accumulation of leukemic cells between the retinal pigment epithelium and Bruch’s membrane. 21 The underlying mechanism has been attributed to choroidal infiltration by leukemic cells, which leads to choriocapillaris ischemia and the disruption of intercellular tight junctions or necrosis of the retinal pigment epithelium.…”

Section: Discussionmentioning

confidence: 99%

“… 21 The underlying mechanism has been attributed to choroidal infiltration by leukemic cells, which leads to choriocapillaris ischemia and the disruption of intercellular tight junctions or necrosis of the retinal pigment epithelium. 22 …”

Section: Discussionmentioning

confidence: 99%

Acute lymphocytic leukemia with initial manifestation of serous retinal detachment and choroidal thickening: case report and literature review

et al. 2021

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This report describes a patient who had acute lymphocytic leukemia with exudative retinal detachment (RD), which mimicked Vogt–Koyanagi–Harada disease (VKH). A 61-year-old woman presented with painless loss of vision in the left eye. Fundus examination revealed RD in her left eye. B-scan ultrasonography confirmed localized RD and choroidal thickening. Fundus fluorescein angiography revealed stippled pinpoint hyperfluorescence in the upper macula. One week later, reduced visual acuity was noted in the right eye. B-scan ultrasonography and optical coherence tomography revealed serous RD in both eyes. A provisional diagnosis of VKH was made. However, subsequent hematologic analysis detected an extremely high leukocyte count. Elevated numbers of leukocytes and tumor cells were found in cerebrospinal fluid. Bone marrow biopsy revealed 77% primary atypical blood cells, 89% of which were immature lymphocytes. The patient was subsequently diagnosed with acute lymphocytic leukemia and transferred to the Department of Hematology. However, the patient and her family refused chemotherapy; she eventually died. Our findings suggest that exudative RD, similar to VKH, could be a sign of leukemia. Pinpoint hyperfluorescence leakage is important for differential diagnosis, particularly with respect to VKH.

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“…Allen & Straatsma (1961) examined the eyes of 76 patients who died from leukaemia and reported an 89% rate of choroidal involvement. Although a diffuse choroidal thickening on SD‐OCT has been described in patients with leukaemia (Bajenova et al, 2012; Choi, 2020; Coupland & Damato, 2008; Takita et al, 2018; Vieira et al, 2015), available imaging studies are mostly anecdotal. None included a quantitative analysis of the choroid and the choriocapillaris.…”

Section: Discussionmentioning

confidence: 99%

Imaging biomarkers of leukaemic choroidopathy

Menean

Apuzzo

Mastaglio

et al. 2023

Acta Ophthalmologica

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Purpose To longitudinally investigate choroidal and choriocapillaris perfusion metrics and the number of choroidal hyperreflective foci (HRF) in patients with acute leukaemia (AL) before and after disease remission and to correlate these metrics with systemic parameters during active disease. Methods Prospective, longitudinal study of 26 eyes of 14 AL patients. All patients underwent optical coherence tomography (OCT) and OCT‐angiography (OCTA) in the acute phase. Subfoveal choroidal thickness (CT), total, luminal and stromal choroidal area (TCA, LCA, SCA), choroidal vascularity index (CVI), choriocapillaris flow deficits (cFD) density, and choroidal HRF number were computed. In a subset, the measurements were repeated after AL remission. Age‐ and gender‐matched 26 healthy controls were recruited for cross‐sectional comparisons. Results Patient's mean age was 59 ± 12 years. The TCA, LCA, SCA and choroidal HRF number were significantly higher in patients than controls (p = 0.028, p = 0.044, p = 0.024 and p = 0.001, respectively). Lower haemoglobin levels were associated with lower CT (r = 0.58, p = 0.008). Higher D‐dimer values were associated with lower TCA (r = −0.52, p = 0.008), lower LCA (r = −0.50, p = 0.006), higher cFD density (r = 0.41, p = 0.044) and higher choroidal HRF number (r = 0.47, p = 0.008). The CT, TCA, SCA and choroidal HRF number significantly reduced after AL remission (p = 0.001, p = 0.047, p = 0.007 and p = 0.002 respectively). The CVI increased significantly compared to the active phase (p = 0.013). Conclusion The study demonstrates a subclinical choroidal involvement in patients with AL, with relative stromal thickening in the acute phase, and normalization after disease remission. Choroidal HRF were identified as a biomarker of leukaemic choroidopathy. Choriocapillaris and choroidal vascularity were inversely correlated with a systemic pro‐coagulant state.

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Acute lymphoblastic leukemia presenting with bilateral serous macular detachment

Cited by 12 publications

References 4 publications

Two cases of differentiation syndrome with ocular manifestations in patients with acute promyelocytic leukaemia treated with all-trans retinoic acid and arsenic trioxide

Two cases of differentiation syndrome with ocular manifestations in patients with acute promyelocytic leukaemia treated with all-trans retinoic acid and arsenic trioxide

Acute lymphocytic leukemia with initial manifestation of serous retinal detachment and choroidal thickening: case report and literature review

Imaging biomarkers of leukaemic choroidopathy

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