Ayliffe W, Foster C S, Marcoux P, Upton M, Finkelstein M, Kuperwaser M, Legmann A
Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston 02114.
Am J Ophthalmol. 1995 Mar;119(3):361-4. doi: 10.1016/s0002-9394(14)71181-x.
Although acute lymphoblastic leukemia may masquerade as hypopyon uveitis, acute myeloid leukemia has only rarely been reported to cause this complication, and ocular relapse generally has been associated with evidence of malignant cells at other sites. We studied a patient with acute myeloid leukemia whose only sign of relapse was bilateral anterior uveitis with pseudohypopyon that was refractory to topical and systemic corticosteroids.
A 26-year-old woman with acute myeloid leukemia in remission, who had bilateral anterior uveitis and increased intraocular pressure at initial examination, was studied clinically. Blood films, bone marrow smears, and preparations were examined by using immunoperoxidase staining.
Although there was no evidence of leukemia in the blood or bone marrow samples, the cells obtained from the anterior chamber showed myeloblastic leukemic cells with morphologic characteristics similar to those present in the original bone marrow biopsy obtained 14 months previously. Irradiation and chemotherapy were used to kill the malignant cells in the eye and central nervous system. The persisting glaucoma resolved after anterior chamber washout of necrotic tumor cells.
Unusual features of uveitis in this patient indicated that she had a masquerade syndrome, despite normal results of bone marrow and blood film tests. Aspiration of intraocular cellular infiltrate for cytopathologic examination was required to obtain the correct diagnosis and enable treatment to commence without delay.
尽管急性淋巴细胞白血病可能伪装成前房积脓性葡萄膜炎，但急性髓系白血病很少被报道会引发这种并发症，并且眼部复发通常与其他部位存在恶性细胞的证据相关。我们研究了一名急性髓系白血病患者，其唯一的复发迹象是双侧前葡萄膜炎伴假性前房积脓，对局部和全身使用的皮质类固醇治疗无效。
对一名26岁处于缓解期的急性髓系白血病女性患者进行临床研究，该患者初次检查时患有双侧前葡萄膜炎且眼压升高。使用免疫过氧化物酶染色对血涂片、骨髓涂片及标本进行检查。
尽管血液或骨髓样本中没有白血病的证据，但从前房获取的细胞显示为髓母细胞性白血病细胞，其形态特征与14个月前最初的骨髓活检中所见的细胞相似。采用放疗和化疗来杀死眼部和中枢神经系统中的恶性细胞。在前房冲洗坏死肿瘤细胞后，持续存在的青光眼得到缓解。
该患者葡萄膜炎的不寻常特征表明她患有伪装综合征，尽管骨髓和血涂片检查结果正常。需要对眼内细胞浸润进行抽吸以进行细胞病理学检查，从而获得正确诊断并及时开始治疗。
