Rapid Resolution of Retinal Haemorrhages Following Initiation of Treatment in a Case of Acute Lymphoblastic Leukaemia

A 23-year-old myopic man presented for a routine check-up. Visual acuity was 6/6, N6. Fundus examination showed bilateral, extensive white-centred haemorrhages [Figure 1a and b]. Further investigations (haemoglobin—5.9 gm/dl, total leucocyte count—920 × 103/µL, platelet count—53000/µL, blast cells—80%, bone marrow biopsy—suggestive of ALL, 85% blasts, flowcytometry—CD 34 positive) revealed a diagnosis of acute lymphoblastic leukaemia (ALL). The patient was started on intensive treatment in the haematology department and received multiple blood transfusions. Two weeks following the presentation, a fundus examination revealed an almost complete resolution of retinal haemorrhages [Figure 1c and d]. Such rapid resolution of retinal haemorrhages is extremely rare. Ophthalmic manifestations in haematological malignancies can be either due to direct tissue infiltration or secondary ocular involvement resulting from haematological abnormalities and treatment complications.[1] This case highlights the importance of prompt diagnosis and early initiation of systemic therapy in ALL cases.Figure 1: (a and b) Colour fundus photograph of the right and left eyes at presentation showing the presence of multiple white-centred retinal haemorrhages. (c and d) Colour fundus photograph of the right and left eyes, two weeks following presentation, showing almost total resolution of the retinal haemorrhagesDeclaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.