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CLINICAL PICTURE
Year : 2022  |  Volume : 13  |  Issue : 4  |  Page : 288

Unilateral vision loss unmasking underlying acute leukemia


Department of Ophthalmology, Institute of Medical Sciences and SUM Hospital, Siksha O Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India

Date of Submission10-Nov-2021
Date of Decision01-Jan-2022
Date of Acceptance09-Jan-2022
Date of Web Publication18-Oct-2022

Correspondence Address:
Dr. Pradeep Kumar Panigrahi
Department of Ophthalmology, Institute of Medical Sciences and SUM Hospital, Siksha O Anusandhan (Deemed to be University), 8-Kalinga Nagar, Bhubaneswar - 751 003, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joah.joah_161_21

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How to cite this article:
Panigrahi PK. Unilateral vision loss unmasking underlying acute leukemia. J Appl Hematol 2022;13:288

How to cite this URL:
Panigrahi PK. Unilateral vision loss unmasking underlying acute leukemia. J Appl Hematol [serial online] 2022 [cited 2022 Dec 4];13:288. Available from: https://www.jahjournal.org/text.asp?2022/13/4/288/358704

A 19-year-old healthy male presented with sudden onset loss of vision in the left eye (LE) of 1-week duration. The patient gave a history of fever, weight loss, and anorexia for the past 1 month. Visual acuity was 6/6 and 1/60 in the right eye (RE) and LE, respectively. Fundus examination of RE was unremarkable. Fundus examination of LE showed plenty of white-centered retinal hemorrhages (Roth's spots) (white arrows) with premacular hemorrhage (yellow arrow) [Figure 1]. Blood investigations showed leukocytosis (30,000/μL), anemia (Hb-9.6 gm%), and thrombocytopenia (70,000/μL). Further hematological investigations led to a diagnosis of B-cell acute lymphoblastic leukemia. Retinopathy can be the initial manifestation of acute leukemia. Presentation is usually bilateral and clinical findings include vascular tortuosity, Roth spots, multi-layered retinal hemorrhages, retinal neovascularization, vitreous hemorrhage, leukemic ad infiltarion. Unilateral retinopathy leading to a diagnosis of acute leukemia is very rare.[1] White-centered retinal hemorrhages in an otherwise healthy patient should lead to a suspicion of hematological disorders.[2] Appropriate investigations will help in arriving at the correct diagnosis.
Figure 1: Colour fundus photograph of left eye showing multiple white centred haemorrhages (white arrows) and pre macular haemorrhage (yellow arrow)

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Seraly MP, Gupta SK, Mehmi I, Veltri L, Ghorayeb GR. A unique case of chronic myeloid leukemia presenting as monocular vision loss with unilateral retinopathy. Am J Ophthalmol Case Rep 2019;14:67-9.  Back to cited text no. 1
    
2.
Istrate M, Ciubotaru A, Hasbei-Popa M, Boariu AM, Iliescu DA. Leukemic retinopathy, the first expression in a case of chronic myelomonocytic leukemia – A case report. Rom J Ophthalmol 2020;64:419-22.  Back to cited text no. 2
    


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