ACUTE VISION LOSS IN ACUTE LYMPHOBLASTIC LEUKEMIA

This case illustrates that hematologic disorders must be considered as a potentially life-threatening cause for vision loss. Proper laboratory workup and timely interdisciplinary approach are essential to ensure the best possible care for ophthalmic patients. Historically, before the use of bone marrow biopsy, the ophthalmologist was often asked to assist in the diagnosis of leukemia. Since ophthalmological symptoms may be the initial presenting signs of leukemia as highlighted in this case, the ophthalmogist is still of crucial importance.

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Acute Lymphoblastic Leukemia Presenting as Acute Vogt-Koyanagi-Harada Syndrome

Case Reports in Ophthalmology ◽

10.1159/000509341 ◽

2020 ◽

Vol 11 (2) ◽

pp. 481-485

Author(s):

Narges Hassanpoor ◽

Mohamad Reza Niyousha

Keyword(s):

Acute Lymphoblastic Leukemia ◽

Vision Loss ◽

Complete Blood Count ◽

Lymphoblastic Leukemia ◽

White Cell Count ◽

Anterior Segment ◽

Subretinal Fluid ◽

Hemoglobin Concentration ◽

Exudative Retinal Detachment ◽

Acute Central Serous Chorioretinopathy

We aimed to describe a case of acute lymphoblastic leukemia (ALL) that initially presented and was managed as Vogt-Koyanagi-Harada syndrome (VKH). A 62-year-old man was referred for vision loss starting 1 week ago. There was no prior systemic or ocular history. Visual acuity was 20/200 in both eyes. Anterior segment exam was also normal in both eyes. On funduscopy, foveal reflex was significantly reduced. On optical coherence tomography, subretinal fluid was evident in both eyes. Fluorescein angiography showed a hypofluorescent area compatible with subretinal fluid and multiple pinpoint hyper- and hypofluorescent dots surrounding the detached retina. After 4 days, we were informed that the patient had been admitted to a general hospital due to spontaneous ecchymosis and melena. On complete blood count, there was a high white cell count, thrombocytopenia, and low hemoglobin concentration with a probable diagnosis of leukemia. On bone marrow biopsy, ALL with B-cell precursor was confirmed. In conclusion, exudative retinal detachment can be a primary presentation of leukemia and/or lymphoma. In atypical VKH or acute central serous chorioretinopathy cases with multiple pinpoint leakages distributed mostly in the periphery of the subretinal fluid area (not randomly scattered throughout the subretinal fluid), we should consider leukemia.

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Acute Lymphoblastic Leukemia Presenting as Pituitary Apoplexy: A Case Report and Review of the Literature

Case Reports in Endocrinology ◽

10.1155/2021/6086756 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Rahul Gupta ◽

Urmimala Bhattacharjee ◽

K. S. Lekshmon ◽

Shakun Chaudhary ◽

Prashant Sharma ◽

...

Keyword(s):

Acute Lymphoblastic Leukemia ◽

Pituitary Adenoma ◽

Vision Loss ◽

Pituitary Apoplexy ◽

Haematological Malignancy ◽

Lymphoblastic Leukemia ◽

Rare Event ◽

Acinetobacter Baumanii ◽

Current Case ◽

Lymphoid Leukemia

Thrombocytopenia as a precipitating factor for pituitary apoplexy (PA) is very rare event. There are only five reported cases of PA secondary to thrombocytopenia caused by underlying haematological malignancy. Herein, we report a case of 60-year-old male presenting with acute-onset headache, bilateral vision loss, and ptosis. Computed tomography and magnetic resonance imaging revealed findings indicative of pituitary adenoma with apoplexy. He was noted to have thrombocytopenia, and bone marrow evaluation revealed precursor B-lineage CALLA-positive acute lymphoblastic leukemia. Accordingly, he was started on dexamethasone and vincristine but succumbed to Acinetobacter baumanii-related hospital-acquired pneumonia two weeks after initiation of chemotherapy. We performed a literature search and found five cases of pituitary apoplexy secondary to haematological malignancy-related thrombocytopenia. The usual age of presentation was in the 6th to 7th decade, and there was slight male preponderance. The underlying pituitary adenoma was either nonfunctioning or a prolactinoma, and in majority, the apoplexy event occurred after the diagnosis of haematological malignancy. The platelet counts at the time of PA were less than 30 × 109/L in all, and the malignancy subtypes were acute or chronic myeloid leukemia and chronic lymphoid leukemia. The current case highlights the importance of careful evaluation for the cause of thrombocytopenia in a case of PA.

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