Ocular involvement—An unusual initial presentation of chronic myeloid leukemia: A case report
Chronic myeloid leukemia (CML) patients frequently exhibit systemic symptoms such as fatigue, abdominal discomfort, weight loss, and fever but rarely can have atypical initial presentation in the form of ophthalmic manifestations, which can precede the diagnosis of the primary malignancy. We describ...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2023-07-01
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| Series: | Journal of Family Medicine and Primary Care |
| Subjects: | |
| Online Access: | https://journals.lww.com/10.4103/jfmpc.jfmpc_2370_22 |
| _version_ | 1826982639837380608 |
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| author | Mittali Khurana Anupam Singh Himani Pal Arvind K. Gupta Barun Kumar |
| author_facet | Mittali Khurana Anupam Singh Himani Pal Arvind K. Gupta Barun Kumar |
| author_sort | Mittali Khurana |
| collection | DOAJ |
| description | Chronic myeloid leukemia (CML) patients frequently exhibit systemic symptoms such as fatigue, abdominal discomfort, weight loss, and fever but rarely can have atypical initial presentation in the form of ophthalmic manifestations, which can precede the diagnosis of the primary malignancy. We describe a case of a 29-year-old male who presented in our ophthalmology out-patient department (OPD) with complaints of painless, diminution of vision, which was sudden in onset in right eye (RE) and loss of vision in left eye (LE) for four and seven days, respectively. There had been a history of loss of weight and appetite for the past 2 months. The visual acuity (VA) recorded was finger counting two meters in RE and perception of light in LE with an inaccurate projection of rays in both eyes (BE). The anterior segment evaluation of both eyes (BE) was normal. Fundus revealed multiple elevated yellow subretinal lesions with exudative detachment in the RE and no view in the LE. Ultrasound-Brightness (USG B) scan in the LE revealed multiple hyperreflective echoes likely vitreous hemorrhage. Optical coherence tomography (OCT) showed subretinal hyperreflectivity with surrounding edema in RE suggestive of leukemic infiltrates. On further systemic investigations, chronic myeloid leukemia-chronic phase (CML-CP) was detected; hence, the diagnosis of RE exudative retinal detachment (RD) and LE vitreous hemorrhage with CML-CP was made. Ophthalmic involvement is more often seen in acute than chronic leukemia, which makes the diagnosis challenging. We describe a unique case of a young patient with CML-CP who initially presented with ocular involvement preceding systemic diagnosis. This case report illustrates the importance of a primary care physician or an ophthalmologist in the early diagnosis and prompt management of hematological malignancy, as ophthalmic manifestations may be a rare initial presenting feature in CML-CP. These conditions require urgent referral to a hematologist by a primary care physician in the view of early commencement of therapy. |
| first_indexed | 2024-03-12T13:45:02Z |
| format | Article |
| id | doaj.art-642567fc375d43d7afb9533d30187773 |
| institution | Directory Open Access Journal |
| issn | 2249-4863 2278-7135 |
| language | English |
| last_indexed | 2025-02-18T06:23:46Z |
| publishDate | 2023-07-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Family Medicine and Primary Care |
| spelling | doaj.art-642567fc375d43d7afb9533d301877732024-11-11T11:08:11ZengWolters Kluwer Medknow PublicationsJournal of Family Medicine and Primary Care2249-48632278-71352023-07-011271460146310.4103/jfmpc.jfmpc_2370_22Ocular involvement—An unusual initial presentation of chronic myeloid leukemia: A case reportMittali KhuranaAnupam SinghHimani PalArvind K. GuptaBarun KumarChronic myeloid leukemia (CML) patients frequently exhibit systemic symptoms such as fatigue, abdominal discomfort, weight loss, and fever but rarely can have atypical initial presentation in the form of ophthalmic manifestations, which can precede the diagnosis of the primary malignancy. We describe a case of a 29-year-old male who presented in our ophthalmology out-patient department (OPD) with complaints of painless, diminution of vision, which was sudden in onset in right eye (RE) and loss of vision in left eye (LE) for four and seven days, respectively. There had been a history of loss of weight and appetite for the past 2 months. The visual acuity (VA) recorded was finger counting two meters in RE and perception of light in LE with an inaccurate projection of rays in both eyes (BE). The anterior segment evaluation of both eyes (BE) was normal. Fundus revealed multiple elevated yellow subretinal lesions with exudative detachment in the RE and no view in the LE. Ultrasound-Brightness (USG B) scan in the LE revealed multiple hyperreflective echoes likely vitreous hemorrhage. Optical coherence tomography (OCT) showed subretinal hyperreflectivity with surrounding edema in RE suggestive of leukemic infiltrates. On further systemic investigations, chronic myeloid leukemia-chronic phase (CML-CP) was detected; hence, the diagnosis of RE exudative retinal detachment (RD) and LE vitreous hemorrhage with CML-CP was made. Ophthalmic involvement is more often seen in acute than chronic leukemia, which makes the diagnosis challenging. We describe a unique case of a young patient with CML-CP who initially presented with ocular involvement preceding systemic diagnosis. This case report illustrates the importance of a primary care physician or an ophthalmologist in the early diagnosis and prompt management of hematological malignancy, as ophthalmic manifestations may be a rare initial presenting feature in CML-CP. These conditions require urgent referral to a hematologist by a primary care physician in the view of early commencement of therapy.https://journals.lww.com/10.4103/jfmpc.jfmpc_2370_22chronic myeloid leukemiaexudative retinal detachmentleukemic retinopathyocular involvementvitreous hemorrhage |
| spellingShingle | Mittali Khurana Anupam Singh Himani Pal Arvind K. Gupta Barun Kumar Ocular involvement—An unusual initial presentation of chronic myeloid leukemia: A case report Journal of Family Medicine and Primary Care chronic myeloid leukemia exudative retinal detachment leukemic retinopathy ocular involvement vitreous hemorrhage |
| title | Ocular involvement—An unusual initial presentation of chronic myeloid leukemia: A case report |
| title_full | Ocular involvement—An unusual initial presentation of chronic myeloid leukemia: A case report |
| title_fullStr | Ocular involvement—An unusual initial presentation of chronic myeloid leukemia: A case report |
| title_full_unstemmed | Ocular involvement—An unusual initial presentation of chronic myeloid leukemia: A case report |
| title_short | Ocular involvement—An unusual initial presentation of chronic myeloid leukemia: A case report |
| title_sort | ocular involvement an unusual initial presentation of chronic myeloid leukemia a case report |
| topic | chronic myeloid leukemia exudative retinal detachment leukemic retinopathy ocular involvement vitreous hemorrhage |
| url | https://journals.lww.com/10.4103/jfmpc.jfmpc_2370_22 |
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