Título

RETINOPATHY BY LEUKEMIC INFILTRATION

Introdução / Purpose

To explain a case which provides a description of the retinopathy by inflitration of blast cells in the funduscopy of a patient suffering an early relapse of T-cell LLA.
A 16-year-old patient diagnosed with T-cell acute lymphocytic leukemia (standard-risk) with initial bone marrow involvement but no central nervous system (CNS) involvement. Complete remission in 2016.
After being disease-free for a year, the patient came to hospital in June 2017 due to reduced visual acuity in the left eye.

Material e Método / Methods

Ophthalmologic and clinical examination
VA OD 20/20 OS 20/200, normal eye movements, orthotropy in primary position. Normal pupillary reflex.
BMC: OU ocular media, no reaction in anterior chamber, no Tyndall effect or pseudohypopyon.
Funduscopy OD: normal OS: At macular level, the retina is retracted to temporal region, long and rectified vessels, in parallel, macular puckers of ganglionic fibers. Vasculitis and vascular sheathing. Widened exudates and peripapillary tissue.

Resultados / Results

MRI of the CNS, lumbar puncture and bone marrow puncture were requested.
Bone Marrow Puncture Aspiration: + blasts in bone marrow
CSF puncture: + blasts
Neuroimaging: Leukemic infiltration suspected.

Discussão e Conclusões / Discussion

According to the clinical and lab conditions and imaging, it was considered to be an early combined relapse (CNS and bone marrow) with poor prognostic factors for survival.
It is essential for doctors specialized in ophtalmology and hematology to be informed and trained in order to detect all different ocular alterations related to leukemic disease, since a timely-managed correct diagnosis can be important not only for patients' visual health, but also for their life.
Abnormal findings in the ophtalmological examination account for a test, including CBC, bone marrow examination, complete systemic staging, lumbar puncture for the CSF citology and imaging.

Palavras Chave

RETINOPATHY BY LEUKEMIC INFILTRATION

Area

CLINICAL RETINA