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Acute Leukemia Relapse Presenting as Recurrent Involvement of the Optic Nerve
반복적인 시신경 침범으로 재발한 급성백혈병
JKOS 2020 Mar;61(3):319-24
Published online March 15, 2020;  https://doi.org/10.3341/jkos.2020.61.3.319
Copyright © 2020 The Korean Ophthalmological Society.
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Seung Yeop Lee, MD, Ji Hyun Yoon, MD, Seung Ah Chung, MD, PhD
이승엽⋅윤지현⋅정승아

Department of Ophthalmology, Ajou University College of Medicine, Suwon, Korea
아주대학교 의과대학 안과학교실
Received April 25, 2019; Revised July 6, 2019; Accepted February 21, 2020.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Purpose: To report two cases with recurrent involvement of the optic nerve as the initial sign of acute leukemic relapse.
Case summary: An 8-year-old male with acute lymphoblastic leukemia on the maintenance chemotherapy was referred for a decrease in visual acuity in the right eye. The visual acuity and optic disc swelling were completely resolved with high-dose steroid therapy. Two months after the initial presentation, the symptoms recurred and brain/orbit magnetic resonance imaging (MRI) showed high intensity along the right optic nerve from the retrobulbar area to the optic chiasm. The visual acuity was restored after high-dose steroid therapy. One month after the second attack, the symptoms recurred and the cerebrospinal fluid cytology was positive for lymphoblasts. Three weeks after the intrathecal chemotherapy, the visual acuity improved fully, but optic disc atrophy developed. A 45-year-old male, who received allogenic peripheral blood stem cell transplantation for acute myeloid leukemia, presented with a decrease in visual acuity in the left eye. The left optic disc swelling improved with high-dose steroid therapy, but the medication was restarted due to the recurrence of symptoms 3 weeks later. Brain MRI showed a mass lesion compressing the left optic nerve, presumed to be a myeloid sarcoma. One month after local irradiation, the visual acuity was no light perception in the left eye.
Conclusions: In patients with a prior history of acute leukemia, the recurrent involvement of the optic nerve should be considered as a central nerve system relapse, regardless of improvement with steroid treatment.
Keywords : Acute lymphoblastic leukemia, Acute myeloid leukemia, Myeloid sarcoma, Optic nerve, Steroids

 

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