Purpose: The aim of this paper is to describe a case of relapsed pediatric acute lymphoblastic leukemia (ALL) presenting as a rapidly progressive subretinal infiltrate, as diagnosed by ultrasound-guided fine needle aspiration (FNA). Methods: We conducted a clinical pathological retrospective chart review. Results: Eleven months after documented remission of T-cell ALL while on maintenance therapy, this 17-year-old patient presented with acute open angle glaucoma in the right eye. B-scan ultrasonography suggested total retinal detachment. Eight weeks later, based on routine cerebrospinal fluid analysis, the patient was diagnosed with central nervous system relapse of T-cell ALL. Repeat B-scan 1 week later showed a new hyperechoic subretinal mass. FNA of the mass confirmed leukemic infiltrate. The involved eye was enucleated, demonstrating leukemic cells throughout the subretinal space, choroid, and the optic nerve. Following hematopoietic stem cell transplant, the patient continues to maintain bone marrow remission 5 months after enucleation without involvement in the opposite eye. Conclusion: Retinal detachment in any patient with a history of leukemia should raise the possibility of relapse and may warrant aspiration/biopsy if other means of diagnosing relapse are inconclusive. Subretinal infiltrate may progress rapidly and prompt diagnosis is paramount to tailoring therapy and preserving vision.

1.
Hunger SP, Mullighan CG: Acute lymphoblastic leukemia in children. N Engl J Med 2015;373:1541-1552.
2.
Russo V, Scott IU, Querques G, Stella A, Barone A, Delle Noci N: Orbital and ocular manifestations of acute childhood leukemia: clinical and statistical analysis of 180 patients. Eur J Ophthalmol 2008;18:619-623.
3.
Reddy SC, Jackson N, Menon BS: Ocular involvement in leukemia - a study of 288 cases. Ophthalmologica 2003;217:441-445.
4.
Somervaille TC, Hann IM, Harrison G, Eden TO, Gibson BE, Hill FG, Mitchell C, Kinsey SE, Vora AJ, Lilleyman JS; MRC Childhood Leukaemia Working Party: Intraocular relapse of childhood acute lymphoblastic leukaemia. Br J Haematol 2003;121:280-288.
5.
Reddy SC, Menon BS: A prospective study of ocular manifestations in childhood acute leukaemia. Acta Ophthalmol Scand 1998;76:700-703.
6.
Yamamoto-Ogasawara A, Asakawa M, Yoshino K, Nagamoto T, Inoue M, Hirakata A: Anterior complications in case of recurrent acute lymphoblastic leukaemia diagnosed by biopsy of aqueous humour. Clin Exp Ophthalmol 2009;37:739-741.
7.
Camera A, Piccirillo G, Cennamo G, Tranfa F, Rosa N, Frigeri F, Martinelli V, Rotoli B: Optic nerve involvement in acute lymphoblastic leukemia. Leuk Lymphoma 1993;11:153-155.
8.
Bajenova NV, Vanderbeek BL, Johnson MW: Change in choroidal thickness after chemotherapy in leukemic choroidopathy. Retina 2012;32:203-205.
9.
Talcott KE, Garg RJ, Garg SJ: Ophthalmic manifestations of leukemia. Curr Opin Ophthalmol 2016;27:545-551.
10.
Ridgway EW, Jaffe N, Walton DS: Leukemic ophthalmopathy in children. Cancer 1976;38:1744-1749.
11.
Lawson SE, Harrison G, Richards S, Oakhill A, Stevens R, Eden OB, Darbyshire PJ: The UK experience in treating relapsed childhood acute lymphoblastic leukaemia: a report on the medical research council UKALLR1 study. Br J Haematol 2000;108:531-543.
12.
Ninane J, Taylor D, Day S: The eye as a sanctuary in acute lymphoblastic leukaemia. Lancet 1980;1:452-453.
13.
Schmiegelow K, Scherfig E, Prause JU, Jensen OA: Isolated leukemic choroidal relapse in a child with acute lymphoblastic leukemia one year off therapy, diagnosed through transvitreal retino-choroidal biopsy. Acta Ophthalmol (Copenh) 1988;66:33-37.
14.
Nagpal MP, Mehrotra NS, Mehta RC, Shukla CK: Leukemic Optic Nerve Infiltration in a Patient with Acute Lymphoblastic Leukemia. Retin Cases Brief Rep 2016;10:127-130.
15.
Primack JD, Smith ME, Tychsen L: Retinal detachment in a child as the first sign of leukemic relapse: histopathology, MRI findings, treatment, and tumor-free follow up. J Pediatr Ophthalmol Strabismus 1995;32:253-256.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.