Ophthalmic Manifestations Revealing Neurological Relapse in T-cell Acute Lymphoblastic Leukemia: A Case Report

The ophthalmic manifestations of acute leukemia are critically important, as ocular involvement may be the sole clinical indicator of the disease or signify a recurrence of leukemia. Ocular manifestations include the orbit, anterior segment, optic nerve, retina, and choroid, with posterior segment involvement being the most prevalent. We report the case of a 19-year-old woman with acute lymphoblastic leukemia (ALL). The patient was in remission after completing the Group for Research on Adult Acute Lymphoblastic Leukemia (GRAALL) protocol. A decrease in visual acuity revealed an infiltration of the anterior and posterior segments of the patient's eye, indicating a disease relapse. A cerebral magnetic resonance imaging (MRI) showed substantial optic nerve infiltration. A lumbar puncture confirmed the recurrence, with a positive result for leukemia. It was a relapse of ALL, unmasked by the ophthalmic involvement, which prompted a change in disease status and treatment. Ocular involvement can sometimes be the first sign of the disease or its recurrence, making it crucial to recognize and address promptly, as it may precede other serious clinical manifestations. Therefore, it is essential to systematically include an ophthalmological examination in the follow-up of patients with acute leukemia.