Subjective intermittent colour vision loss as the initial presentation of chronic myeloid leukemia

Abstract

Purpose To report a case of subjective intermittent loss of bilateral colour vision and episodic white-out vision in a patient with undiagnosed chronic myeloid leukemia (CML). Observations A patient initially diagnosed with diabetic retinopathy presented with a chief complaint of subjective intermittent loss of colour vision in both eyes, as well as intermittent bilateral white-out vision. These symptoms previously went uninvestigated until a thorough history revealed concurrent constitutional symptoms including recent night sweats and fevers. Closer fundus examination revealed that the lesions previously thought to be diabetic retinal hemorrhages were Roth spots. Conclusions: and Importance An unusual chief complaint of colour vision loss and multiple Roth spots in the context of chronic night sweats and fevers prompted further workup. A CBC with differential revealed a markedly increased WBC count and the patient was diagnosed with CML. Cytoreduction therapy led to complete resolution of the patient's visual symptoms and a return to normal WBC count at the most recent follow up appointment. We report, to our knowledge, the only case of colour vision loss as the initial presenting symptom of CML in the current literature, and reiterate the importance of a thorough history, neuro-ophthalmic examination and relevant investigations in patients with unusual visual symptoms, including intermittent loss of colour vision. In this case, we speculate that hyperviscosity syndrome secondary to CML was the cause of this patient's peculiar visual disturbance.

Chronic myeloid leukemia revealed by bilateral proliferative retinopathy: A case report and literature review

“…In the present case report, CML presented with bilateral proliferative retinopathy-a rare finding in chronic leukemias. Although retinopathy is a rare complication of CML; however, retina is the most affected intraocular structure in this lethal hematological malignancy [8]. Most often, CML remains asymptomatic, and up to half of the patients have ocular manifestations at the time of diagnosis [9].…”

“…However, bilateral proliferative retinopathy is a rare complication of CML as a few cases have been reported in the literature to date. Retina is the most common intraocular part affected by CML in terms of vascular abnormalities such as tortuous vessels, retinal or vitreous hemorrhage, microanevrysms and neovascularization [8]. This is an interesting case report as the visual manifestations of bilateral proliferative retinopathy led to the diagnosis of CML.…”

Unilateral disc edema as the first presentation of chronic myeloid leukemia

“…Although leukemic cells in the CSF fluid may be undetected, it is unlikely that our patient's presentation was a result of that. In the setting of chronic leukemias, optic nerve swelling is postulated to be secondary to obstruction of CSF outflow through the arachnoid granulations due to hyperviscosity of the blood in the setting of elevated white blood cells [1,4,7,10] . The mechanism in accordance with the initial ophthalmological picture in our patient is controversial.…”