Unilateral Optic Nerve Leukemic Infiltration and Exudative Retinal Detachment as Initial Manifestations of Central Nervous System Relapse in Acute Lymphoblastic Leukemia of Children

Hsi Kung Kuo

doi:10.4172/2155-9570.1000359

Abstract

Acute lymphoblastic Leukemia (ALL) is a malignant neoplasm caused by the proliferation of poorly differentiated precursors of the lymphoid cells, which are known as blast cells. It is primarily the most common type of childhood Leukemia. Although 70-80% with ALL is cured with modern chemotherapy, 20-30% still have to endure relapse, particularly in the central nervous system (CNS) after attainment of remission. Treatment to prevent recurrence is based on cranial irradiation and intrathecal chemotherapy after conventional induction chemotherapy and the achievement of complete remission. However, the orbital cavity and optic nerve are relatively unaffected by being shielded during brain irradiation and serve as sanctuaries of ALL. Here, we describe a 12-year-old boy with ALL for one year who achieved complete remission after induction chemotherapy. He developed sudden loss of ipsilateral vision prior to CNS relapse twice. His initial ocular presentations noted on ophthalmic examination are unilateral optic nerve Leukemic infiltration and exudative retinal detachment (RD) respectively.

Highlights

central nervous system (CNS) involvement is becoming more frequent with more diagnostic and therapeutic treatments have allowed an improvement of the survival of patients suffering from Acute lymphoblastic Leukemia (ALL)
The patient is a 12-year-old boy with remission of his ALL, who presented with sudden onset of visual dimness in his left eye
Prior to his first episode of CNS relapse, optic disc edema was noted on ophthalmic examination

Summary

Introduction

Examination of CSF performed one week earlier did not reveal any Leukemic cells. His cytological examination of the CSF revealed infiltration by several blasts, which was suggestive of CNS Leukemia. We continued to perform intrathecal continuation chemotherapy and regressed exudative RD and neovascular glaucoma with high intraocular pressure of 33 mmHg were found in his left eye during his follow-up. His exudative RD partially regressed with residual subretinal infiltrates (Figure 4) but loss his visual acuity (negative light perception) in left eye.

Results

Conclusion