A 51-year-old woman with binocular diplopia and unilateral ptosis

Abstract

HistoryA 51-year-old woman with a history of acute myeloid leukemia (AML) in remission and no past ocular history presented emergently at the University of Kansas Hospital with binocular diplopia and right-sided ptosis of 3 days' duration. The patient also complained of fatigue. She originally attributed her symptoms to allergies, stating that she had also recently experienced mild rightsided eye discharge and sinus pressure. Past medical history was significant for mild hypertension and AML with myelodysplasia-related features that was treated about 6 months prior with haploidentical peripheral stem-cell transplantation. The patient was a former smoker (40 pack-years) and had a family history of glaucoma (sister). She had recently finished a regimen of fluconazole for prophylaxis after stem-cell transplantation and was also taking acyclovir, letermovir, dapsone, and tacrolimus. TreatmentIntrathecal chemotherapy was started on day 3, and the patient was discharged 4 days later with plans for weekly intrathecal chemotherapy (Figure 3). The