Leukemic Infiltration of the Optic Nerve Head as the Initial Manifestation of Leukemic Relapse.

Park, Saemi; Park, Seong Kyu; Park, Tae Kwann

doi:2011.52.2.250

J Korean Ophthalmol Soc > Volume 52(2); 2011 > Article

Case Report

Journal of the Korean Ophthalmological Society 2011;52(2):250-254.
DOI: https://doi.org/10.3341/jkos.2011.52.2.250 Published online February 15, 2011.

Leukemic Infiltration of the Optic Nerve Head as the Initial Manifestation of Leukemic Relapse.

Saemi Park, Seong Kyu Park, Tae Kwann Park

¹Department of Ophthalmology, Soonchunhyang University College of Medicine, Bucheon, Korea. genophilus@hanmail.net
²Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.

급성골수구성백혈병에서 재발의 첫 임상증상으로 나타난 시신경유두 침범의 1예

박새미¹⋅박성규²⋅박태관¹

Department of Ophthalmology, Soonchunhyang University College of Medicine¹, Bucheon, Korea Department of Internal Medicine, Soonchunhyang University College of Medicine², Bucheon, Korea

Abstract

PURPOSE
To present a case of leukemic infiltration of the optic nerve head as the initial manifestation of leukemic relapse. CASE SUMMARY: A 65-year-old woman was diagnosed with acute myeloid leukemia. Complete remission was achieved after 4 complete courses of chemotherapy. She complained of a sudden decrease in visual acuity in her left eye. Fundus examination showed severe optic disc edema with peripapillary hemorrhage and serous retinal detachment. Visual acuity and fundus continued to aggravate and high-dose intravenous steroid therapy was instituted. Visual acuity and fundus deteriorated more after treatment. Brain magnetic resonance imaging and CSF study were normal but intrathecal chemotherapy and focal irradiation were performed on account of the suspected CNS involvement of leukemia. Morphologic improvement in the retinal structure was achieved, however, optic atrophy remained and her vision did not recover. CONCLUSIONS: The present case shows the involvement of the optic nerve head as the initial isolated manifestation for the relapse in a patient with complete remission. CNS involvement is rare in acute myeloid leukemia and in particular, the optic nerve is rarely reported as the initial isolated presentation for the relapse. Moreover, the disease progression relatively aggravated after treatment. In the atypical aspects of leukemic relapse, the present case was noticeable.

Key Words: Acute myeloid leukemia;CNS involvement of leukemia;Optic disc edema