Acute lymphocytic leukemia with initial manifestation of serous retinal detachment and choroidal thickening: case report and literature review

Abstract

This report describes a patient who had acute lymphocytic leukemia with exudative retinal detachment (RD), which mimicked Vogt-Koyanagi-Harada disease (VKH). A 61-year-old woman presented with painless loss of vision in the left eye. Fundus examination revealed RD in her left eye. B-scan ultrasonography confirmed localized RD and choroidal thickening. Fundus fluorescein angiography revealed stippled pinpoint hyperfluorescence in the upper macula. One week later, reduced visual acuity was noted in the right eye. B-scan ultrasonography and optical coherence tomography revealed serous RD in both eyes. A provisional diagnosis of VKH was made. However, subsequent hematologic analysis detected an extremely high leukocyte count. Elevated numbers of leukocytes and tumor cells were found in cerebrospinal fluid. Bone marrow biopsy revealed 77% primary atypical blood cells, 89% of which were immature lymphocytes. The patient was subsequently diagnosed with acute lymphocytic leukemia and transferred to the Department of Hematology. However, the patient and her family refused chemotherapy; she eventually died. Our findings suggest that exudative RD, similar to VKH, could be a sign of leukemia. Pinpoint hyperfluorescence leakage is important for differential diagnosis, particularly with respect to VKH.

Keywords: Exudative retinal detachment; Vogt–Koyanagi–Harada disease; acute lymphocytic leukemia; choroidal thickening; fluorescein angiography; leukocytes; macula lutea; optical coherence tomography; ultrasonography; uveomeningoencephalitic syndrome.

Figure 1.

B-scan ultrasonography of both eyes during the patient’s first visit. Localized retinal detachment (white arrow) and choroidal thickening (black arrow) were evident in the left eye, while the right eye appeared normal. OD, right eye; OS, left eye.

Figure 2.

Fundus photography and fundus fluorescein angiography of the left eye. Fundus fluorescein angiography revealed stippled pinpoint hyperfluorescence, temporal and superior to the macula of the left retina (yellow arrows).

Figure 3.

B-scan ultrasonography of both eyes, 1 week after the onset of ocular signs. B-scan ultrasonography revealed obvious retinal detachment in both eyes (white arrows). OD, right eye; OS, left eye.

Figure 4.

Optical coherence tomography images of both eyes, 1 week after the onset of ocular signs. Optical coherence tomography confirmed serous retinal detachment under the macula in both eyes (white arrows). OD, right eye; OS, left eye.