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JAMA Ophthalmology Clinical Challenge
March 2018

White Retinal Lesions in a Patient With Leukemia

Author Affiliations
  • 1Vanderbilt Eye Institute, Nashville, Tennessee
JAMA Ophthalmol. 2018;136(3):301-302. doi:10.1001/jamaophthalmol.2017.4333

A 25-year-old white man with acute lymphoblastic leukemia reported blurry vision in the left eye for 24 hours and gradually worsening floaters for 1 week. He was already admitted for induction chemotherapy after a relapse of his acute lymphoblastic leukemia. The findings of a previous inpatient eye examination performed 3 weeks earlier were unremarkable. During his hospitalization, he was noted to have persistent fevers of unclear origin and neutropenia. He was receiving prophylactic cefepime and amphotericin B prescribed by the infectious diseases service. Up to this point, the results of multiple systemic cultures were negative other than a skin biopsy specimen of a concerning papular rash that was noted to yield Candida tropicalis. Vision was 20/20 OD and 20/100 OS. He denied any pain or photophobia. Anterior segment examination findings were unremarkable. Dilated fundoscopy revealed multiple yellow-white subretinal lesions with associated hemorrhages and vitritis in the left eye (Figure 1).