A Rare Ophthalmic Presentation of Acute Lymphoblastic Leukemia in an Adult Male: A Case Report

This case report discusses a 35-year-old male patient who presented with bilateral painless proptosis as the initial manifestation of Acute Lymphoblastic Leukemia (ALL). He exhibited fever, back pain, and fatigue, leading to magnetic resonance imaging (MRI) of the brain and orbit, which suggested lymphoma. Positron Emission Tomography-Computed Tomography (PET-CT) revealed the findings suspicious of lymphoma. The diagnosis was confirmed through peripheral smear (82% blasts), bone marrow biopsy, flow cytometry indicating B-cell ALL, and a positive Philadelphia chromosome t (9:22) on FISH panel. Ocular involvement in ALL, particularly in adults, is rare, and this case demonstrates the importance of early diagnosis and multidisciplinary management. The patient responded positively to chemotherapy, with a significant reduction in proptosis. However, despite ongoing treatment for supportive care, the patient unfortunately expired six months later. Key words: Proptosis, Acute Lymphoblastic Leukemia, Ophthalmic manifestation, B-cell ALL, Philadelphia chromosome