单侧视力模糊作为慢性淋巴细胞白血病的唯一首发症状
Unilateral Blurred Vision as the Sole Presenting Symptom of Chronic Lymphocytic Leukemia.
作者信息
Sharma Rajesh K, Mays Kevin
机构信息
Department of Ophthalmology, University of Mississippi Medical Center, Jackson, MS, USA.
Department of Neurology, University of Mississippi Medical Center, Jackson, MS, USA.
出版信息
J Ophthalmic Vis Res. 2020 Feb 2;15(1):109-112. doi: 10.18502/jovr.v15i1.5958. eCollection 2020 Jan-Mar.
PURPOSE
To describe a case of infiltrative optic neuropathy caused by chronic lymphocytic leukemia.
CASE REPORT
A 41-year-old white male presented with painless, blurry vision in the left eye. Examination revealed unilateral optic nerve swelling confirmed by optical coherence tomography (OCT). Initial workup revealed mild leukocytosis, eventually diagnosed as chronic lymphocytic leukemia (CLL). No other cause of optic neuropathy was identified despite extensive investigation. The patient developed rapidly progressive retinal ganglion cell nerve fiber layer (NFL) atrophy and relative afferent pupillary defect (RAPD) of the left eye despite steroid treatment but stabilized after four cycles of CLL-targeted chemotherapy. Although infiltrative optic neuropathy is well-known in leukemia, presentation with only subtle vision loss is rare. Vision loss usually presents late in leukemic infiltrative optic neuropathy and therefore must be considered in patients with optic disc swelling and leukocytosis.
CONCLUSION
When treating CLL, progressive visual decline with coexistent optic neuropathy may warrant chemotherapy.
目的
描述一例由慢性淋巴细胞白血病引起的浸润性视神经病变。
病例报告
一名41岁的白人男性，左眼出现无痛性视力模糊。检查发现光学相干断层扫描（OCT）证实单侧视神经肿胀。初步检查显示轻度白细胞增多，最终诊断为慢性淋巴细胞白血病（CLL）。尽管进行了广泛的调查，但未发现其他视神经病变的原因。尽管接受了类固醇治疗，患者左眼仍迅速出现进行性视网膜神经节细胞神经纤维层（NFL）萎缩和相对传入性瞳孔障碍（RAPD），但在进行四个周期的CLL靶向化疗后病情稳定。虽然浸润性视神经病变在白血病中很常见，但仅表现为轻微视力丧失的情况很少见。视力丧失通常在白血病浸润性视神经病变后期出现，因此在视盘肿胀和白细胞增多的患者中必须考虑到这一点。
结论
在治疗CLL时，伴有视神经病变的进行性视力下降可能需要进行化疗。
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