Rare Presentation of Bilateral Central Retinal Vein Occlusion and Leukemic Retinopathy in a Young Adult Diagnosed with T-cell Acute Lymphoblastic Leukemia

Abstract

Simultaneous bilateral central retinal vein occlusion (CRVO) is a rare presentation that warrants consideration of an underlying hyperviscosity state. Increased serum viscosity can lead to the hematologic emergency of leukostasis with resultant vascular obstruction and hypoxic tissue damage. The following case demonstrates the first case of bilateral CRVO in a young adult secondary to acute lymphoblastic leukemia (ALL). A 23-year-old female presented to the emergency department (ED) with two days of worsening bilateral blurry vision and bitemporal headache. Her ocular exam was significant for bilateral intraretinal hemorrhages consistent with CRVO with chest radiograph demonstrating widened mediastinum with perihilar lymphadenopathy and serologic testing revealing ALL with blast crisis. The patient was subsequently admitted to the oncology service for induction chemotherapy. Patients with new headache and bilateral vision changes should prompt a thorough neurological and ophthalmologic exam to assess for underlying systemic pathologies. Concurrent bilateral CRVO is a rare but specific finding for systemic hyperviscosity syndrome, blood dyscrasia, polycythemia, or other serious illness. Early recognition and treatment of the underlying condition can prevent further vision loss and overall morbidity and mortality.

Bilateral Central Retinal Vein Occlusion Secondary to Leukostasis in the Setting of Diffuse Large-B Cell Lymphoma: Case Report

“…This can be linked to underlying conditions such as hyperviscosity, vasculopathy or other blood dyscrasias. 5 The patient in this report demonstrated a case of bilateral non-ischaemic CRVO secondary to leukostasis. To our knowledge, no previous case report has documented this complication in the setting of DLBCL.…”

“…This can be linked to underlying conditions such as hyperviscosity, vasculopathy or other blood dyscrasias. 5 …”

Bilateral Central Retinal Vein Occlusion as a First Presentation of Multiple Myeloma: A Case Report

“…Bilateral CRVO is exceedingly rare, and its presentation has been documented in only a handful of case studies in association with hypercoagulable and hyperviscous states. [6][7][8] In the rare case of bilateral CRVO, the differential diagnosis should include systemic lupus erythematosus, acute myeloid leukemia, Waldenstrom's macroglobinemia, antiphospholipid antibody syndrome, and dysproteinemias. 9 Multiple myeloma is most commonly diagnosed in the presence of hypercalcemia, renal insufficiency, anemia, and the presence of osteolytic bone lesions on skeletal radiography.…”

The role of optical coherence tomography in the diagnosis of the leukemic infiltration of the optic nerve and retina

“…Заболевания зрительного нерва и сетчатки у больных гемобластозами многообразны. Изменение вязкости и реологических свойств крови нередко вызывает окклюзию сосудов сетчатки [6]. Поражение головного мозга с развитием церебральной гипертензии приводит к появлению застойного ДЗН.…”