Saadeldine Salah Marwan, Alammouri Yara Mohammad
Department of Internal Medicine (Oncology), Faculty of Medicine, Damascus University, AL fayhaa Hospital.
Department of Internal Medicine (Neurology), Faculty of Medicine, Damascus University, AL fayhaa Hospital, Damascus, Syrian Arab Republic.
Ann Med Surg (Lond). 2024 Sep 12;86(10):6335-6339. doi: 10.1097/MS9.0000000000002570. eCollection 2024 Oct.
Chronic myeloid leukemia (CML) is the most common leukemia in adults. It can present with a wide variable range of symptoms and signs related to the phase of the disease. Ophthalmic manifestations as the first presentation of CML are unique, although they can occur during any stage of the disease. Ocular lesions in CML patients may be asymptomatic, so all patients should undergo an eye evaluation at the initial diagnosis.
The authors report a case of a 17-year-old Syrian male who initially presented with progressive loss of vision, fatigue, and abdominal pain. Clinical examination showed bilateral retinal aneurysm hemorrhage, jaundice, and splenomegaly. Bone marrow biopsy results were consistent with the diagnosis of CML returning to AML. The patient was treated with intensive chemotherapy and then prepared for hematopoietic transplantation.
CML can present with variable symptoms and signs, but the ophthalmic manifestations are uncommon. Ophthalmic problems occur either from infiltration of neoplastic cells or from secondary causes, like thrombocytopenia, leukocytosis, hyperviscosity syndrome, or leukoembolization. In the literature, only some case reports presented eye involvement in CML as the first manifestation.
Although this is a rare presentation of CML, we believe that it should be taken into consideration when managing these situations to obtain the right diagnosis and better treatment results. Collaboration between hematologists and ophthalmologists is necessary in deciding the treatment. Acute myeloid leukemia needs immediate medical attention and different treatment from CML.
慢性髓系白血病（CML）是成人中最常见的白血病。它可表现出与疾病阶段相关的广泛多样的症状和体征。尽管CML的眼部表现可发生在疾病的任何阶段，但作为CML的首发表现却很独特。CML患者的眼部病变可能无症状，因此所有患者在初诊时均应接受眼部评估。
作者报告了一例17岁叙利亚男性病例，该患者最初表现为进行性视力丧失、疲劳和腹痛。临床检查显示双侧视网膜动脉瘤出血、黄疸和脾肿大。骨髓活检结果与CML转化为急性髓系白血病（AML）的诊断一致。该患者接受了强化化疗，然后准备进行造血移植。
CML可表现出多样的症状和体征，但其眼部表现并不常见。眼部问题要么源于肿瘤细胞浸润，要么源于继发性原因，如血小板减少、白细胞增多、高粘滞综合征或白细胞栓塞。在文献中，仅有一些病例报告将CML的眼部受累作为首发表现。
尽管这是CML的一种罕见表现，但我们认为在处理这些情况时应予以考虑，以获得正确的诊断和更好的治疗效果。血液科医生和眼科医生之间的合作对于确定治疗方案是必要的。急性髓系白血病需要立即就医，其治疗与CML不同。
