Massive retinal infiltrates as the presenting sign of chronic myeloid leukemia: Clinical and imaging features of leukemic retinopathy.

Autor:	Szeto SK; The Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China.; Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China., Mohamed S; The Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China.; Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China., Tsang CW; The Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China.; Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China., Chan CK; The Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China.; Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
Jazyk:	angličtina
Zdroj:	European journal of ophthalmology [Eur J Ophthalmol] 2023 Jan; Vol. 33 (1), pp. NP55-NP63. Date of Electronic Publication: 2021 Oct 01.
DOI:	10.1177/11206721211048792
Abstrakt:	Purpose: To describe the clinical and optical coherence tomography (OCT) features of two cases with bilateral diffuse retinal infiltrates as the only presenting feature of chronic myeloid leukemia (CML) on initial diagnosis and upon relapse. Methods: We reported two patients with CML, one at initial diagnosis and one in remission who presented with bilateral subacute visual impairment. Fundal examination revealed bilateral symmetrical leukostatic appearance with increased vascular tortuosity, diffuse retinal infiltrates with size up to 6 disk diameters, retinal hemorrhages, and Roth's spots. OCT showed multiple intra-retinal hyper-reflective foci corresponding to intra-retinal hemorrhages, and outer retinal hyper-reflective foci in area corresponding to retinal infiltrate. The different retinal layers were relatively preserved and distinguishable. Results: White cell count (WCC) were elevated in both patients ranging from 544 to 810 × 10 9 /L. Bone marrow biopsy confirmed the diagnosis of CML in the patient without prior diagnosis and relapse of CML in another patient. Cytogenetic test detected Abelson murine leukemia (ABL) - breakpoint cluster region (BCR) fusion transcript in both cases. Both patients were started on oral imatinib, subsequently WCC returned to within normal values in both cases. Vision and OCT abnormalities improved and reduction in retinal hemorrhages and infiltrates were observed in follow up. Conclusion: This report highlights the important role of ophthalmologists and detailed fundus examination in making a prompt diagnosis of leukemia in patients with visual complaints. Appropriate systemic investigation and hematologist referrals for prompt treatment of CML may improve survival rate and preserve vision.
Databáze:	MEDLINE
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