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

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. CasePresentation: 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.

Extramedullary Relapse of Acute Myelogenous Leukemia Presenting as a Large Serous Retinal Detachment

“…Less common still is serous retinal detachment as the presenting sign of recurrence. Of the 7 cases of ALL recurrence presenting with serous retinal detachment that we were able to identify in the literature, 4 [12,13,14,15] reported bone marrow and/or central nervous system involvement at the time of presentation or within 6 months; 1 [16] reported subsequent systemic involvement shortly after presentation, but did not report a specific time frame; 1 [17] reported no systemic involvement immediately upon presentation, but gave no follow-up; and 1 [18] specifically reported the lack of systemic involvement through 18 months of follow-up.…”

Ophthalmic Manifestations in Patients with Blood Malignancies

“…Nodular retinal infiltrates occur in association with elevated leukocyte counts and are the result of leukostasis and direct retinal infiltration in both acute and chronic pathologies [ 45 , 46 ]. Infiltrates are often described as grayish-white and may involve the foveal area, affecting vision [ 47 , 48 ].…”