J Korean Ophthalmol Soc.  2020 Mar;61(3):319-324. 10.3341/jkos.2020.61.3.319.

Acute Leukemia Relapse Presenting as Recurrent Involvement of the Optic Nerve

Affiliations
  • 1Department of Ophthalmology, Ajou University College of Medicine, Suwon, Korea. mingming8@naver.com

Abstract

PURPOSE
To report two cases with recurrent involvement of the optic nerve as the initial sign of acute leukemic relapse. CASE SUMMARY: An 8-year-old male with acute lymphoblastic leukemia on the maintenance chemotherapy was referred for a decrease in visual acuity in the right eye. The visual acuity and optic disc swelling were completely resolved with high-dose steroid therapy. Two months after the initial presentation, the symptoms recurred and brain/orbit magnetic resonance imaging (MRI) showed high intensity along the right optic nerve from the retrobulbar area to the optic chiasm. The visual acuity was restored after high-dose steroid therapy. One month after the second attack, the symptoms recurred and the cerebrospinal fluid cytology was positive for lymphoblasts. Three weeks after the intrathecal chemotherapy, the visual acuity improved fully, but optic disc atrophy developed. A 45-year-old male, who received allogenic peripheral blood stem cell transplantation for acute myeloid leukemia, presented with a decrease in visual acuity in the left eye. The left optic disc swelling improved with high-dose steroid therapy, but the medication was restarted due to the recurrence of symptoms 3 weeks later. Brain MRI showed a mass lesion compressing the left optic nerve, presumed to be a myeloid sarcoma. One month after local irradiation, the visual acuity was no light perception in the left eye.
CONCLUSIONS
In patients with a prior history of acute leukemia, the recurrent involvement of the optic nerve should be considered as a central nerve system relapse, regardless of improvement with steroid treatment.

Keyword

Acute lymphoblastic leukemia; Acute myeloid leukemia; Myeloid sarcoma; Optic nerve; Steroids

MeSH Terms

Atrophy
Brain
Cerebrospinal Fluid
Child
Drug Therapy
Humans
Leukemia*
Leukemia, Myeloid, Acute
Magnetic Resonance Imaging
Maintenance Chemotherapy
Male
Middle Aged
Optic Chiasm
Optic Nerve*
Peripheral Blood Stem Cell Transplantation
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Recurrence*
Sarcoma, Myeloid
Steroids
Visual Acuity
Steroids
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