Neurotrophic ulcer as the presenting symptom of central nervous system invasion in precursor B-cell lymphoblastic leukemia: a case report

It is not uncommon that ophthalmologists encounter life-threatening conditions masquerading as common ocular complaints. We present a case of a 33-year-old male with neurotrophic corneal ulcer as the initial symptom of intracranial spread of precursor B-cell lymphoblastic leukemia. This was rapidly followed by affection of nerves VI, III on the right side, and II, VII on the left side. Work-up included MRI, magnetic resonance venography, and cerebrospinal fluid analysis to exclude various causes of multiple cranial neuropathies. Cerebrospinal fluid analysis revealed the presence of malignant cells, and intrathecal chemotherapy was initiated.