Korean J Ophthalmol.  2009 Dec;23(4):325-328. 10.3341/kjo.2009.23.4.325.

Acute Lymphoblastic Leukemia Manifesting as Acute Vogt-Koyanagi-Harada Disease

• Yang HK
• Yu HG

• KMID: 754775
• DOI: http://doi.org/10.3341/kjo.2009.23.4.325

Abstract

We describe a case of bilateral exudative retinal detachment associated with prodromal symptoms simulating the presentation of acute Vogt-Koyanagi-Harada disease that was eventually diagnosed as acute lymphoblastic leukemia. A 42-year-old man presented with sudden visual loss in both eyes for two weeks. He complained of intermittent headache, neck stiffness and tinnitus for a month. His best-corrected visual acuities were 20/200 in both eyes. Fluorescein angiography, optical coherence topography and indocyanine green angiography featured bilateral serous retinal detachments. A clinical diagnosis of incomplete type Vogt-Koyanagi-Harada disease was considered. However, complete blood cell count showed a marked increase in the number of white blood cells and bone marrow examination revealed precursor B cell lymphoblastic leukemia. The patient started on induction chemotherapy. A week later, his best-corrected visual acuities were 20/25 and the serous retinal detachments were nearly absorbed in both eyes. Bilateral exudative retinal detachment associated with neurologic and auditory abnormalities may be a presenting sign of acute lymphoblastic leukemia. Clinicians should be aware of the possibility of leukemia in such patients.

Keyword

Exudative retinal detachment; Leukemia; Vogt-Koyanagi-Harada disease

MeSH Terms

Adult
Diagnosis, Differential
Fluorescein Angiography
Follow-Up Studies
Fundus Oculi
Humans
Male
Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications/*diagnosis
Retinal Detachment/diagnosis/*etiology
Tomography, Optical Coherence
Uveomeningoencephalitic Syndrome/*diagnosis
Visual Acuity

Figure

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  Fig. 1 Initial presentation. Fundus photo of both eyes showing exudative retinal detachment. An Elschnig's spot (white arrow) is seen in the left eye.

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  Fig. 2 Optical coherence tomography of the macula in both eyes showed massive subretinal exudative fluid in the posterior pole. No subretinal septa were observed.

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  Fig. 3 Fluorescence angiography (FA) and indocyanine green angiography (ICGA) of the right eye. (A) Mid-phase FA showed patchy choroidal filling and multiple punctate hyperfluorescent lesions. (B) Late-phase FA showed diffuse leakage and unilobular fluorescence pooling. (C) Early-phase ICGA (35 sec) showed a hypofluorescent choroidal filling defect in the macula. (D) Mid-phase ICGA (4 min) showed a larger area of macular hypofluorescence due to fluorescence blockage in the areas of exudative retinal detachment.

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  Fig. 4 One week after chemotherapy. (A) Fundus photo of the left eye showed nearly absorbed serous retinal detachments with newly appeared retinal hemorrhage (black arrow) and Roth spots (white arrow). (B) Fluorescence angiography of the left eye no longer showed multilple hyperfluorescent lesions in the late phase.

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