Bilateral Hypopyon Uveitis in Chronic Myeloid Leukemia

Abstract

Background: A leukemic hypopyon is considered an early sign of central nervous system involvement or systemic relapse. A differential diagnosis of masquerade syndromes should be considered in cases of hypopyon uveitis that are atypical or unresponsive to treatment. We report a case of a 45-year-old man who presented with bilateral hypopyon uveitis and was subsequently diagnosed as having chronic myeloid leukemia.

Method: Retrospective case review.

Results: A 45-year-old diabetic male presented with diminished vision in both eyes for 10 days. Ophthalmic evaluation revealed rubeosis iridis, hypopyon, and signs of proliferative diabetic retinopathy with panretinal laser photocoagulation scars. He subsequently presented 1 week later with a bloodstained hypopyon in his right eye and a persistent hypopyon in his left eye. A peripheral blood smear and subsequent bone marrow trephine biopsy confirmed the diagnosis of chronic myeloid leukemia in blast crisis and he was referred to an oncologist for further management.

Conclusion: A recalcitrant or atypical hypopyon uveitis can be an indicator of a blast crisis or a central nervous system involvement or sign of a relapse in cases of leukemia. The presence of unusual bloodstained hypopyon helped in identifying the presence of chronic myeloid leukemia and aided in a prompt oncology consultation.

Keywords: Chronic myeloid leukemia; Hypopyon; Masquerade syndromes.

Fig. 1

Slit-lamp photograph of the patient at the time of presentation showing a hypopyon in the right (a) and left eye (b). He presented 1 week later with a sudden decrease in vision in his right eye, which had developed a bloodstained hypopyon (c). The left eye had a persistent hypopyon (d). Peripheral blood smear (Leishman stain) showing an increased shift to the left of leukocytes (e, 40× magnification), marked leukocytosis (f, 10× magnification), and presence of promyelocytes, metamyelocytes, myeloblasts, and band cells (g, h).