Veerappan Pasricha Malini, Callaway Natalia F, Nguyen Quan Dong, Do Diana V
Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA, 94303, USA.
Am J Ophthalmol Case Rep. 2021 Jun 22;23:101142. doi: 10.1016/j.ajoc.2021.101142. eCollection 2021 Sep.
To describe a unique case of unilateral serous retinal detachment as the presenting sign of B-cell acute lymphoblastic leukemia (ALL).
A 74 year old woman presented with right eye blurry vision and was found to have an underlying serous retinal detachment, along with cotton wool spots, inner retinal hemorrhages, and retinal pigment epithelial changes throughout her bilateral fundi. Fluorescein angiography demonstrated bilateral vasculitis and ultrasonography revealed asymmetric thickening and enhancement of the affected eyes' choroid. This prompted a systemic lab workup and results were suspicious for an underlying hematologic malignancy. The patient was admitted to the hospital for bone marrow biopsy confirming B-cell ALL, underwent intensive intravenous and intrathecal chemotherapy, and was discharged one month later. Follow up appointment in the ophthalmology clinic demonstrated functional and anatomic improvement in the serous retinal detachment and choroidal thickening suggestive of infiltration in her right eye.
SRDs are an uncommon ocular manifestation of leukemia, and even less common as a presenting sign of the disease. A comprehensive literature review demonstrated 11 other cases reported worldwide. We present the first such case with additional findings of leukemic retinopathy, optic nerve and choroidal infiltration, and vasculitis, as well as a complete library of ophthalmic imaging from the patient's initial presentation.
A new diagnosis of serous retinal detachment(s) without any obvious cause should raise suspicion for leukemia and prompt further workup. Early recognition of this hematologic malignancy is crucial for prompt initiation of life-saving therapy.
描述一例以单侧浆液性视网膜脱离为首发症状的B细胞急性淋巴细胞白血病（ALL）的独特病例。
一名74岁女性因右眼视物模糊就诊，检查发现存在浆液性视网膜脱离，双侧眼底可见棉絮斑、视网膜内出血及视网膜色素上皮改变。荧光素血管造影显示双侧血管炎，超声检查显示患侧脉络膜不对称增厚及强化。这促使进行全身实验室检查，结果怀疑存在潜在的血液系统恶性肿瘤。患者入院接受骨髓活检，确诊为B细胞ALL，接受了强化静脉和鞘内化疗，1个月后出院。眼科门诊的随访显示，浆液性视网膜脱离和脉络膜增厚有功能和解剖学上的改善，提示右眼存在浸润。
浆液性视网膜脱离是白血病一种不常见的眼部表现，作为该病的首发症状则更为罕见。全面的文献综述显示，全球另有11例相关病例报道。我们报告的这例首例病例，还伴有白血病性视网膜病变、视神经和脉络膜浸润以及血管炎等额外表现，以及患者初次就诊时完整的眼科影像资料。
新发无明显病因的浆液性视网膜脱离应引起对白血病的怀疑，并促使进一步检查。早期识别这种血液系统恶性肿瘤对于及时启动挽救生命的治疗至关重要。
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