Kommaraju Kaushik R, Moroi Sayoko, Demirci Hakan
*Medical School, William Carey University, Hattiesburg, MS; and †Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI.
Cornea. 2014 Aug;33(8):873-4. doi: 10.1097/ICO.0000000000000180.
The aim of this study was to report a case of adult T-cell prolymphocytic leukemia (T-PLL), which presented with diffuse anterior scleritis and increased intraocular pressure.
This is a case report.
A 57-year-old man presented with bilateral conjunctival hyperemia and chemosis associated with pain. He also complained of having fatigue, general weakness, and disequilibrium. His visual acuity was 20/20 bilaterally. His intraocular pressures were 34 mm Hg oculus dexter (OD) and 35 mm Hg oculus sinister (OS). His anterior segments were noted for moderate conjunctival injection, deep anterior chambers with +2 anterior chamber cells and flare, no abnormalities of iris structures, and mild nuclear sclerosis. His optic discs showed vertical cup-to-disc ratios of 0.4 oculus dexter and 0.7 oculus sinister. On B-scan ultrasonography, mild fluid in the sub-Tenon space and a thickening of the uvea were observed in both eyes. The patient was diagnosed with bilateral diffuse anterior scleritis and secondary glaucoma. Systemic evaluation revealed adult T-PLL with pulmonary, abdominal, and pelvic adenopathy; pleural effusion; and central nervous system (CNS) involvement. He was treated with systemic alemtuzumab and intrathecal alternating cytarabine/hydrocortisone and methotrexate/hydrocortisone. His lymphadenopathy decreased in size and the pleural effusion, scleritis, and secondary glaucoma resolved; however, his CNS disease was unresponsive. He was therefore given craniospinal irradiation with a total dose of 29.4 Gy. Despite radiotherapy, the CNS disease progressed, and the patient died 19 months after the presentation.
Scleritis with secondary glaucoma, although usually associated with inflammatory conditions, can rarely be a manifestation of adult T-PLL.
本研究旨在报告一例成人T细胞原淋巴细胞白血病（T-PLL），该病例表现为弥漫性前巩膜炎和眼压升高。
这是一例病例报告。
一名57岁男性出现双侧结膜充血、水肿并伴有疼痛。他还主诉有疲劳、全身无力和平衡失调。他的双眼视力均为20/20。右眼眼压为34 mmHg，左眼眼压为35 mmHg。眼前节检查发现结膜中度充血，前房深，前房细胞++，有闪光，虹膜结构无异常，晶状体轻度核硬化。他的视盘垂直杯盘比右眼为0.4，左眼为0.7。B超检查显示双眼Tenon囊下轻度积液和葡萄膜增厚。该患者被诊断为双侧弥漫性前巩膜炎和继发性青光眼。全身评估发现成人T-PLL伴肺、腹部和盆腔淋巴结肿大；胸腔积液；以及中枢神经系统（CNS）受累。他接受了全身阿仑单抗治疗以及鞘内交替使用阿糖胞苷/氢化可的松和甲氨蝶呤/氢化可的松治疗。他的淋巴结肿大缩小，胸腔积液、巩膜炎和继发性青光眼消退；然而，他的中枢神经系统疾病无反应。因此，他接受了总剂量为29.4 Gy的全脑全脊髓照射。尽管进行了放疗，中枢神经系统疾病仍进展，患者在就诊后19个月死亡。
巩膜炎伴继发性青光眼虽然通常与炎症性疾病有关，但很少是成人T-PLL的表现。
