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Unilateral optic nerve relapse after acute lymphoblastic leukaemia remission

Published online by Cambridge University Press:  09 February 2021

Alia Mousli ,
Rim Abidi ,
Safia Yahyeoui ,
Samia Zarraa ,
Asma Belaid  and
Chiraz Nasr
Alia Mousli*
Affiliation:
Department of Oncology Radiotherapy, Institute of Salah Azaiez, Tunis, Tunisia University Tunis El Manar, Tunis, Tunisia
Rim Abidi
Affiliation:
Department of Oncology Radiotherapy, Institute of Salah Azaiez, Tunis, Tunisia University Tunis El Manar, Tunis, Tunisia
Safia Yahyeoui
Affiliation:
Department of Oncology Radiotherapy, Institute of Salah Azaiez, Tunis, Tunisia University Tunis El Manar, Tunis, Tunisia
Samia Zarraa
Affiliation:
Department of Oncology Radiotherapy, Institute of Salah Azaiez, Tunis, Tunisia University Tunis El Manar, Tunis, Tunisia
Asma Belaid
Affiliation:
Department of Oncology Radiotherapy, Institute of Salah Azaiez, Tunis, Tunisia University Tunis El Manar, Tunis, Tunisia
Chiraz Nasr
Affiliation:
Department of Oncology Radiotherapy, Institute of Salah Azaiez, Tunis, Tunisia University Tunis El Manar, Tunis, Tunisia
*
Author for correspondence: Alia Mousli, Department of Oncology Radiotherapy, Institute of Salah Azaiez, Tunis, Tunisia. E-mail: [email protected]
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Abstract

Background:

The aim of this case report is to describe the clinical presentation and imaging features of a patient with optic nerve leukaemic infiltration as the first site of relapse after complete response to systemic treatment.

Materials and methods:

We report the case of a 23-year-old man with history of acute lymphoblastic leukaemia (ALL) in complete remission. Six months later, the ocular examination revealed decreased visual acuity. Fundus examination showed a pale optic disk with blurred margins and multiple flame-shaped and dot and blot retinal haemorrhages in his left eye. A diagnosis of leukaemic infiltration to the optic nerve was made by magnetic resonance imaging (MRI). Cytological analysis of the cerebrospinal fluid did not show any abnormal cells or blasts.

Results:

A course of oral corticosteroid therapy was prescribed and 20 Gy of radiation was administered to the whole brain including the left orbit. Vision was improved dramatically in the left eye. Isolated optic nerve relapse of leukaemic infiltration is of paramount importance to early diagnosis, as vision can be saved if treatment with orbital radiotherapy is initiated promptly.

Keywords

leukaemiaoptic nerveradiotherapyrelapse
Type
Case Study
Information
Journal of Radiotherapy in Practice , Volume 21 , Issue 2 , June 2022 , pp. 294 - 296
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

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 (2): 127–130.CrossRefGoogle Scholar
Bandyopadhyay, S, Das, D, Das, G, Gayen, S. Unilateral optic nerve infiltration as an initial site of relapse of acute lymphoblastic leukemia in remission. Oman J Ophthalmol 2010; 3 (3): 153–154.CrossRefGoogle ScholarPubMed
Taylor, CW, Taylor, RE, Kinsey, SE. Leukemic infiltration of the orbit: report of three cases and literature review. Pediatr Hematol Oncol 2005; 22 (5): 415–422.CrossRefGoogle ScholarPubMed
Ridgway, EW, Jaffe, N, Walton, DS. Leukemic ophthalmopathy in children. Cancer 1976; 38 (4): 1744–1749.3.0.CO;2-3>CrossRefGoogle ScholarPubMed
Surapaneni, UR, Cortes, JE, Thomas, D, O’Brien, S, Giles, FJ, Koller, C, et al. Central nervous system relapse in adults with acute lymphoblastic leukemia. Cancer 2002; 94 (3): 773–779.CrossRefGoogle ScholarPubMed
Kincaid, MC, Green, WR. Ocular and orbital involvement in leukemia. Surv Ophthalmol 1983; 27 (4): 211–232.CrossRefGoogle ScholarPubMed
Ninane, J, Taylor, D, Day, S. The eye as a sanctuary in acute lymphoblastic leukaemia. Lancet Lond Engl 1980; 1 (8166): 452–453.CrossRefGoogle ScholarPubMed
Brandão, MM, Soares, E, Salles, TS, Saad, ST. Expression of inducible nitric oxide synthase is increased in acute myeloid leukaemia. Acta Haematol 2001; 106 (3): 95–99.CrossRefGoogle ScholarPubMed
Merle, H, Richer, R, Donnio, A, Jean-Charles, A. Leukemic infiltration of the optic nerve. J Fr Ophtalmol 2006; 29 (9): e25.CrossRefGoogle ScholarPubMed
Kaikov, Y. Optic nerve head infiltration in acute leukemia in children: an indication for emergency optic nerve radiation therapy. Med Pediatr Oncol 1996; 26 (2): 101–104.3.0.CO;2-P>CrossRefGoogle ScholarPubMed
Curto, ML, D’Angelo, P, Jankovic, M, Fugardi, MG, Ziino, O, Casale, F. Isolated ocular relapse in childhood acute lymphoblastic leukemia during continuing complete remission. Haematologica 1996; 81 (1): 47–50.Google ScholarPubMed
Morris, E, Buck, G, Bailey, C, et al. Prognostic factors and outcome for children after second central nervous system relapse of acute lymphoblastic leukaemia. Br J Haematol 2003; 120: 787–789.CrossRefGoogle ScholarPubMed
Shenoy, SB, Karam, T, Udupa, K, Nayal, B. Leukaemic infiltration of the optic nerve head: a rare site of initial relapse. BMJ Case Rep 2016.CrossRefGoogle ScholarPubMed