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

Bodaghi, Bahram; Thépot, Sylvain; Chapiro, Élise; Nguyen‐Khac, Florence; Charlotte, Frédéric; LeHoang, Phuc; Maloum, Karim

doi:10.1002/ajh.23693

Cited by 9 publications

(5 citation statements)

References 6 publications

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“…However, isolated ocular relapse without systemic involvement of AML is particularly rare. To our knowledge, there are 3 reported cases of this in the paediatric population with ocular presentations of hypopyon [ 11 ] and choroidal infiltrates with serous retinal detachment [ 12 , 13 ], while the 5 reported adult cases had ocular presentations of choroidal infiltrates [ 1 , 14 , 15 ], conjunctival infiltrates [ 10 ], and hypopyon [ 16 ]. Two of the reported paediatric cases presented with choroidal infiltrates culminating in serous retinal detachments [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Isolated Ocular Relapse of Acute Myeloid Leukaemia Post Allogeneic Stem Cell Transplant

Tong,

Kwok,

Walsh

et al. 2024

Case Reports in Ophthalmological Medicine

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We present a rare case of a 39-year-old female with extramedullary relapse of acute myeloid leukaemia (AML) isolated to the left eye 2 months post allogeneic haematopoietic stem cell transplant. She initially presented with painless left eye erythema, swelling, and visual impairment. Initial ophthalmology review revealed conjunctival chemosis, raised intraocular pressure, and serous retinal detachments. She was initially treated for suspected orbital cellulitis with intravenous antibiotic and antifungal therapy but clinically progressed so was then treated with intravenous corticosteroids. One week later, she progressed to angle-closure glaucoma with development of a hypopyon and an enlarging subconjunctival mass. She proceeded to urgent subconjunctival biopsy and drainage of subretinal fluid which confirmed extramedullary relapse of AML. Notably, further investigation found no evidence of bone marrow or central nervous system relapse. She proceeded to localized radiotherapy with gradual resolution of the subconjunctival mass and serous retinal detachment and was for consideration of donor lymphocyte infusions and azacitidine therapy; unfortunately, she developed respiratory sepsis and passed away despite maximal efforts. This case represents a rare and unusual presentation of isolated ocular extramedullary relapse of AML and emphasises the importance of early ophthalmology involvement and tissue biopsy when there is high clinical suspicion of the disease.

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Section: Discussionmentioning

confidence: 99%

Isolated Ocular Relapse of Acute Myeloid Leukaemia Post Allogeneic Stem Cell Transplant

Tong,

Kwok,

Walsh

et al. 2024

Case Reports in Ophthalmological Medicine

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“… 71 While leukemic hypopyon is strongly associated with the presence of extramedullary infiltration, especially CNS leukemia, some rare cases of isolated ocular relapse have been reported. 70 , 72 , 75 , 76 Authors have suggested that leukemic hypopyon is associated with systemic relapse even when systemic evaluation does not detect leukemia and concluded that systemic chemotherapy combined with local therapy is advised in these patients. 71 …”

Section: Methodsmentioning

confidence: 99%

Early Ophthalmological Manifestations of Acute Myeloid Leukemia: Current Perspectives

Salloukh¹,

Hage²,

Bashshur³

et al. 2022

OPTH

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Acute myeloid leukemia (AML) is a hematological malignancy affecting different organ systems including the eye. The purpose of this review is to present and evaluate the medical literature regarding the early ophthalmological manifestations of acute myeloid leukemia. AML affects the ocular system through direct infiltration of tissues, secondary to hematological abnormalities, or in the form of chloroma or myeloid sarcoma in the brain or orbit consequently leading to a variety of manifestations depending on the ocular tissue involved. It is imperative for ophthalmologists to be aware of the early ophthalmological manifestations of AML which will allow for earlier diagnosis and treatment of this life-threatening disease.

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“…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.…”

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confidence: 98%

“…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. The immuneprivileged microenvironment, coupled with low penetration of chemotherapeutics, may allow the anterior chamber to shelter malignant seeds, leaving it susceptible to relapse.…”

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confidence: 98%

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

Cited by 9 publications

References 6 publications

Isolated Ocular Relapse of Acute Myeloid Leukaemia Post Allogeneic Stem Cell Transplant

Isolated Ocular Relapse of Acute Myeloid Leukaemia Post Allogeneic Stem Cell Transplant

Early Ophthalmological Manifestations of Acute Myeloid Leukemia: Current Perspectives

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