Author: Aida Jallouli (Tunisia)
Co-authors: Saloua Ben amor, Sofien Affes, Mona Rekik, Rahma Mesfar, Sonda Kamoun, Amira Trigui
Purpose
To report a case of bilateral serous retinal detachment with choroidal thickening in acute bilineal leukemia.
Setting/Venue
Department of Ophtalmplogy , Habib Bourguiba University Hospital , Faculty of medicine , University of Sfax , Tunisia
Methods
A 25-year-old man, presented with sudden vision loss of the left eye since 3 days. His personal medical history included bilineal acute leukemia treated initially with acute lymphoblastic leukemia chemotherapy protocol with persistence of predominant myeloblasts population at his presentation to our department . Complete ophthalmologic examination, fluorescein angiography and optical coherence tomography were performed.
Results
On examination, best corrected visual acuity was 8/10 in both eyes. No obvious inflammation in the anterior chamber or vitreous was found. Biomicroscopic fundus examination revealed bilateral serous retinal detachment (SRD) in the posterior pole . We noted the presence of an optic disc pit in the right eye. Fluorescein angiography showed in both eyes multiple and diffuse leakage points (pinpoint pattern) distributed mostly in the periphery of the subretinal fluid area and pooling of dye corresponding to SRD in the late phase. Spectral domain optical coherence tomography showed a multiple SRD,hypereflective deposits above the pigmentary epithelium, retinal folds and overall thickening of the choroid with alterations of its layers while the architecture of the retinal layers was preserved in both eyes. B-scan ultrasonography revealed bilateral choroidal thickening. This choroidal thickness increase, associated with the SRD, was interpreted as a choroidal leukemic infiltration. Unfortunately, the patient passed away few days after his medical checkup in our department.
Conlusions
Bilineal leukemia is type of mixed phenotypal acute leukemia that comprises acute leukemias with admixed populations of myeloid and lymphoid blasts. Ocular involvement is common in acute leukemia; it has been reported to occur in up to 90% of patients with this disease. Intraretinal hemorrhages, cotton wool spots, Roth spots and optic nerve head infiltration are fairly common in the fundus of leukemic patients. On the opposite side , SRD, sign of choriocapillaris ischemia secondary to choroidal leukemic infiltration, is a less common ocular finding in leukemia. It has been described in acute lymphoblastic leukemia and less frequently in acute myeloblastic leukemia. This is the first case describing SRD as manifestation of bilineal leukemia. Our case emphasis also the importance of optical coherence tomography imaging which offers a detailed description of the choroidal features when choroidal infiltration is suspected in leukemic cases.
Financial Disclosure
no financial disclosure
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