Choroidal infiltrates simulating fundal changes of acute leukemia during hematological recovery following high-dose chemotherapy in acute myelomonocytic leukemia in remission

Ghosh, Kanjaksha; Mitra, Sandip; Hiwase, Devendra

doi:10.1002/(sici)1096-8652(200001)63:1<42::aid-ajh10>3.0.co;2-m

Cited by 4 publications

(1 citation statement)

References 6 publications

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“…However, isolated ocular relapse without systemic involvement of AML is particularly rare. To our knowledge, there are 3 reported cases of this in the paediatric population with ocular presentations of hypopyon [ 11 ] and choroidal infiltrates with serous retinal detachment [ 12 , 13 ], while the 5 reported adult cases had ocular presentations of choroidal infiltrates [ 1 , 14 , 15 ], conjunctival infiltrates [ 10 ], and hypopyon [ 16 ]. Two of the reported paediatric cases presented with choroidal infiltrates culminating in serous retinal detachments [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Isolated Ocular Relapse of Acute Myeloid Leukaemia Post Allogeneic Stem Cell Transplant

Tong,

Kwok,

Walsh

et al. 2024

Case Reports in Ophthalmological Medicine

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We present a rare case of a 39-year-old female with extramedullary relapse of acute myeloid leukaemia (AML) isolated to the left eye 2 months post allogeneic haematopoietic stem cell transplant. She initially presented with painless left eye erythema, swelling, and visual impairment. Initial ophthalmology review revealed conjunctival chemosis, raised intraocular pressure, and serous retinal detachments. She was initially treated for suspected orbital cellulitis with intravenous antibiotic and antifungal therapy but clinically progressed so was then treated with intravenous corticosteroids. One week later, she progressed to angle-closure glaucoma with development of a hypopyon and an enlarging subconjunctival mass. She proceeded to urgent subconjunctival biopsy and drainage of subretinal fluid which confirmed extramedullary relapse of AML. Notably, further investigation found no evidence of bone marrow or central nervous system relapse. She proceeded to localized radiotherapy with gradual resolution of the subconjunctival mass and serous retinal detachment and was for consideration of donor lymphocyte infusions and azacitidine therapy; unfortunately, she developed respiratory sepsis and passed away despite maximal efforts. This case represents a rare and unusual presentation of isolated ocular extramedullary relapse of AML and emphasises the importance of early ophthalmology involvement and tissue biopsy when there is high clinical suspicion of the disease.

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