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

Affiliations
  • 1Department of Ophthalmology, Seoul National University College of Medicine, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea. hgonyu@snu.ac.kr

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

  • 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.

  • 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.

  • 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.

  • 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.


Reference

1. Zimmerman LE, Thoreson HT. Sudden loss of vision in acute leukemia: a clinicopathologic report of two unusual cases. Surv Ophthalmol. 1964. 146:467–473.
2. Stewart MW, Gitter KA, Cohen G. Acute leukemia presenting as a unilateral exudative retinal detachment. Retina. 1989. 9:110–114.
3. Chen MT, Wu HJ. Acute leukemia presenting as diabetes insipidus and bilateral exudative retinal detachment: a case report. Kaohsiung J Med Sci. 2001. 17:150–155.
4. Fackler TK, Bearelly S, Odom T, et al. Acute lymphoblastic leukemia presenting as bilateral serous macular detachments. Retina. 2006. 26:710–712.
5. Hine JE, Kingham JD. Myelogenous leukemia and bilateral exudative retinal detachment. Ann Ophthalmol. 1979. 11:1867–1872.
6. Kincaid MC, Green WR, Kelley JS. Acute ocular leukemia. Am J Ophthalmol. 1979. 87:698–702.
7. Malik R, Shah A, Greaney MJ, Dick AD. Bilateral serous macular detachment as a presenting feature of acute lymphoblastic leukemia. Eur J Ophthalmol. 2005. 15:284–286.
8. Paydas S, Soylu MB, Disel U, et al. Serous retinal detachment in a case with chronic lymphocytic leukemia: no response to systemic and local treatment. Leuk Res. 2003. 27:557–559.
9. Read RW, Holland GN, Rao NA, et al. Revised diagnostic criteria for Vogt-Koyanagi-Harada disease: report of an international committee on nomenclature. Am J Ophthalmol. 2001. 131:647–652.
10. Leonardy NJ, Rupani M, Dent G, Klintworth GK. Analysis of 135 autopsy eyes for ocular involvement in leukemia. Am J Ophthalmol. 1990. 109:436–444.
11. Gaudric A, Sterkers M, Coscas G. Retinal detachment after choroidal ischemia. Am J Ophthalmol. 1987. 104:364–372.
12. Spaide RF, Goldbaum M, Wong DW, et al. Serous detachment of the retina. Retina. 2003. 23:820–846.
13. Ito YN, Mori K, Young-Duvall J, Yoneya S. Aging changes of the choroidal dye filling pattern in indocyanine green angiography of normal subjects. Retina. 2001. 21:237–242.
14. Oshima Y, Harino S, Hara Y, Tano Y. Indocyanine green angiographic findings in Vogt-Koyanagi-Harada disease. Am J Ophthalmol. 1996. 122:58–66.
15. Fang W, Yang P. Vogt-koyanagi-harada syndrome. Curr Eye Res. 2008. 33:517–523.
16. Yamaguchi Y, Otani T, Kishi S. Tomographic features of serous retinal detachment with multilobf seroye pooling in aeroye Vogt-Koyanagi-Harada disease. Am J Ophthalmol. 2007. 144:260–265.
17. Demopoulos A, DeAngelis LM. Neurologic complications of leukemia. Curr Opin Neurol. 2002. 15:691–699.
18. Resende LS, Coradazzi AL, Rocha-Junior C, et al. Sudden bilateral deafness from hyperleukocytosis in chronic myeloid leukemia. Acta Haematol. 2000. 104:46–49.
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