Leukemic hypopyon in acute myelogenous leukemia

Abstract

We encountered a patient with acute myelogenous leukemia (AML) who developed leukemic hypopyon. Leukemia initially spread into the pharynx, gingiva, lymphnode, and bone marrow. He achieved complete remission after chemotherapy but developed blurred vision and hypopyon. Anterior chamber paracentesis disclosed leukemic infiltration of the anterior chamber. Infiltration of the central nervous system also occurred. He received systemic chemotherapy, intrathecal chemotherapy, and local chemotherapy. However, he did not achieve prolonged remission. These findings suggest that these chemotherapy treatments have an inadequate effect for AML with anterior chamber infiltration. This rare complication is associated with extramedullary infiltration of leukemia.

When the eye gives it all: Diagnosis of relapsing acute myeloblastic leukemia with anterior chamber tap of a chronic hypopyon

“…Intraocular location of AML is extremely rare . Leukemic hypopyon has mostly been reported with acute lymphoid leukemia .…”

Intraocular Relapse with Hypopyon and Retinal Infiltrates after Chemotherapy and Peripheral Blood Stem Cell Transplantation for Extranodal NK/T-Cell Lymphoma

“…Hypopyon, also known as pseudohypopyon, as well as vitreous opacity, are two major manifestations of intraocular involvement with lymphoma [1][2][3][4] or leukemia. [5][6][7] Nasal-type extranodal NK/T-cell lymphoma is a type of malignant lymphoma defined in the 2008 version of the World Health Organization (WHO) Classification of Tumors of Hematopoietic and Lymphoid Tissues. [8][9][10] The course of the disease is aggressive, and the treatment requires intensive chemotherapy 11 and hematopoietic stem cell transplantation.…”

Blurred Vision

“…Evaluation of cases with diffuse disease accompanying pseudohypopyon revealed that 9 of 14 patients received a diagnosis of either M4 or M5 AML. 6 In the 1 case of long-term survival after presentation of the pseudohypopyon, the patient showed no other evidence of extramedullary leukemic infiltration outside the eye. 5 This uncommonly successful outcome impresses the importance of prompt identification of AML relapse.…”

“…Since then, there have been multiple cases documenting the pseudohypopyon in AML. [5][6][7] Increased reports of pseudohypopyon in AML should prompt evolving clinical approaches. This unusual manifestation of AML relapse portends a grave prognosis.…”

“…Among 15 patients, 13 died within months after presentation of the pseudohypopyon. [5][6][7] At time of presentation, all 15 had already developed diffuse systemic disease, but not all involved the central nervous system. In our patient, no evidence of leukemia was detected by brain magnetic resonance imaging and he declined a lumbar puncture.…”