Sight Threatening or Life Threatening: A Case Report of Ocular Manifestation in Acute Lymphoblastic Leukaemia

Abstract

Background: Acute lymphoblastic leukaemia (ALL) is the commonest childhood malignancy and ocular manifestations are uncommon in ALL. Patients may present with non-specific systemic symptoms which are overlooked and life threatening symptoms of leukostasis often present late. Here, we present a rare case of ALL where ocular symptoms preceded constitutional symptoms. Materials and Methods: A case report. Result: A 11-year-old girl presented with a syncopal attack during the fasting month to a primary health center. She was investigated at a tertiary center and diagnosed to have ALL. Further history revealed she had sudden painless severe reduced vision in the right for one month prior to this. Ocular assessment noted her right visual acuity was 5/60 and left visual acuity was 6/6. Her right fundus had a large subhyaloid haemorrhage over the macula and multiple large white-centered haemorrhages (Roth's spot); while the left fundus showed multiple large Roth's spots and some intraretinal haemorrhages. Chemotherapy was instituted after immunophenotyping was reported as precursor B-cell ALL. Ocular condition was managed conservatively. There was total resolution of the subhyaloid haemorrhage and retinal haemorrhages in both eyes and she regained full vision bilaterally while on induction therapy over 5 months. Conclusion: Life threatening conditions such as ALL should be considered in children with sudden, painless, reduced vision and urgent ophthalmology assessment is important for early detection. Blurry vision could be the earliest symptom in ALL. Awareness on eye health must be emphasized in school by the educators for early detection of both sight and life threatening condition among children.