Arteritic anterior ischemic optic neuropathy associated with chronic myelomonocytic leukemia (CMML): A case report

Abstract

Introduction: Ocular involvement in patients with CMML is rarely reported, owing in part to the fact that the severe illness faced by many of these patients limits the feasibility of ocular examinations. Nevertheless, post-mortem examination of the eyes of patients without ophthalmological symptoms and diagnosis of CMML, has revealed ocular infiltration of atypical cells. Case report: A 72-year-old man presented with two days of left-sided blurring of vision and an episode of transient visual obscuration associated to periorbitary pain. A relative afferent pupillary defect was present in the LE. Fundus examination revealed optic disc swelling in LE. The erythrocyte sedimentation rate (ESR) was 120 mm (1 st hour) and C-reactive protein was 7.8. Complementary examinations yielded normal findings. A presumptive diagnosis of arteritic anterior ischemic optic neuropathy (AAION) was made. Treatment with endovenous bolus of methylprednisolone, followed by slow-tapering of oral steroids, was started, without improvement. Temporal artery biopsy confirmed the diagnosis. Conclusions: To our knowledge, this is the second case in peer-reviewed literature reporting the association between AAION and CMML. A possible explanation is the fact that small vessel vasculitis, of unclear pathogenesis so far, complicates approximately 10% of CMML and presents as cutaneous vasculitis and lupus-like syndromes. Therefore, this may be in relation with the vasculitis of the short posterior ciliary arteries which happens in cases of AAION.