Isolated Ocular Manifestations in Chronic Myeloid Leukaemia

Anita Maniam,Hanis Zuhaimy,Othmaliza Othman,Francesca Martina M Vendargon

doi:10.7759/cureus.19450

Abstract

Background: Chronic myeloid leukaemia (CML) presenting with only ocular manifestations either at the initial stage of diagnosis or at relapse is uncommon. We report two cases of CML presenting with isolated visual symptoms.Case series: The first case is a 21-year-old healthy gentleman who presented with left eye painless loss of vision for a one-week duration. Visual acuity was 6/60 in the left eye and 6/6 in the right eye. There were scattered retinal haemorrhages in both eyes and a sub-macular bleed over the left eye. The full blood count revealed a high white cell count of 134.6 × 109/L. Peripheral blood smear showed hyper-leucocytosis with absolute eosinophilia and basophilia and the presence of blasts suggestive of CML thus chemotherapy was commenced. The second case is a 28-year-old in haematological, molecular, and cytogenic remission from CML for the past two years, presented with left eye painless vision loss for five days duration. Vision in the left eye was counting fingers. There was a large subretinal mass involving the left optic disc. Magnetic resonance imaging of the brain and orbit showed an elliptical orbital mass at the left globe posteriorly with diffuse thickening of the optic nerve. The patient was diagnosed as CML relapsed to the left optic nerve. He underwent intrathecal chemotherapy and orbital irradiation.Conclusion: Both these cases are unique since the manifestation of CML was with only ocular features at the time of presentation as per in the first case during the initial diagnosis and in the second case during relapse. This highlights that it is evident that the knowledge of ocular involvement in leukaemia is crucial since the eye is the only organ where leukemic infiltration to nerves and blood vessels can be observed directly. Recognizing fundus changes in leukaemia allows earlier diagnosis and prompt treatment. These case reports highlight the importance of recognizing early fundus changes, which should allow earlier diagnosis and treatment.

Highlights

Chronic myeloid leukaemia (CML) is a malignant proliferative disorder involving the bone marrow and lymphatic system
It is unusual for ocular manifestations to be the initial presenting sign for the diagnosis of CML as studies have shown that only 5-10% of CML patients present with eye symptoms at initial diagnosis and even rarer to be the initial feature for CML relapse [2]
Ocular complications of leukaemia are known to be due to direct infiltration of the orbit and other ocular tissues such as iris, choroid, optic nerve, or as a result of vascular abnormalities affecting the retina exhibiting as leukemic retinopathy

Summary

Conclusion

Both these cases are unique since the manifestation of CML was with only ocular features at the time of presentation as per in the first case during the initial diagnosis and in the second case during relapse. This highlights that it is evident that the knowledge of ocular involvement in leukaemia is crucial since the eye is the only organ where leukemic infiltration to nerves and blood vessels can be observed directly. Recognizing fundus changes in leukaemia allows earlier diagnosis and prompt treatment. Categories: Ophthalmology, Hematology Keywords: irradiation, chemotherapy, orbital mass, retinal haemorrhage, chronic myeloid leukaemia (cml)

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