A 51-year-old man diagnosed as having acute promyelocytic leukemia, undergoing induction therapy with all-trans-retinoic acid (ATRA) and arsenic trioxide that were started 2 weeks prior, presented with sudden loss of vision. Hospital course was complicated by neutropenic fever, receiving cefepime, acyclovir, vancomycin, and voriconazole for prophylaxis. Laboratory test results were remarkable for pancytopenia. On initial examination, his visual acuity was count fingers at 3 ft in both eyes. Intraocular pressures were 10 mm Hg OD and 11 mm Hg OS. Pupils were round and reactive without a relative afferent pupillary defect. Color plates were 1 of 8 OU, with 50% brightness desaturation in the right eye and no red desaturation. Extraocular movements were full. Slitlamp examination was negative for any signs of inflammation. Dilated fundus examination demonstrated bilateral choroidal effusions with diffuse serous retinal detachments (RD) involving the macula without vitritis as well as white centered intraretinal hemorrhages along peripapillary and superior and inferior arcade distributions in both eyes (Figure, A). Optical coherence tomography demonstrated irregular inner retinal surface and subretinal fluid with septae with loss of the ellipsoid zone (Figure, B). Review of systems was positive for fever, tachycardia, odynophagia, productive cough with wheezing, and marked peripheral edema in upper extremities and negative for headache, nausea, vomiting, dysacusis, meningismus, or skin changes.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Hua H, Rayess N, Moshfeghi AA. Acute Promyelocytic Leukemia With Sudden Vision Loss. JAMA Ophthalmol. 2020;138(2):206–207. doi:10.1001/jamaophthalmol.2019.4838
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: