An unusual and incidental diagnosis of acute promyelocytic leukaemia through eye casualty

Abstract

This case study reports a young man with hypertension who presented to eye casualty and was incidentally diagnosed with acute promyelocytic leukaemia (APML). Dilated fundus examination showed multiple retinal flame haemorrhages from the optic discs with scattered exudates bilaterally. Optical coherence tomography showed left cystoid macular oedema. He had preserved vision bilaterally and was systemically well with no constitutional symptoms. This case report is the first of our knowledge that reports on this unusual clinical presentation of APML. The patient successfully completed 29 days of induction all-trans-retinoic acid/arsenic trioxide therapy with repeat bone marrow biopsy showing haematological remission. Ophthalmic review 2 months later revealed resolution of retinal haemorrhages and cystoid macular oedema. Retinal haemorrhages may be the initial and only manifestation of APML. A full blood count should be considered in patients who present to eye casualty with haemorrhagic retinopathy of unknown aetiology.

Keywords: APML; acute promyelocytic leukaemia; leukaemic retinopathy; retinal haemorrhages.

Figure 1

Ultra-widefield red–green retinal image of the right eye (A) and left eye (B), with scattered retinal haemorrhages extending from the optic nerve head. Optical coherence tomography of the macula of the right eye (C) and left eye (D). Right eye (C) shows a normal macula. Left eye (D) shows retinal thickening with intraretinal cystic areas and a foveal pigmented epithelial detachment.

Figure 2

Ultra-widefield red–green retinal image of the right eye (A) and left eye (B) 2 months after completion of induction therapy, with resolved haemorrhagic retinopathy. Optical coherence tomography of the macula of the right eye (C) and left eye (D) 2 months after completion of induction therapy, both showing normal maculae.