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Ophthalmic Images
April 21, 2021

Ocular Relapse of B-Cell Acute Lymphoblastic Leukemia

Author Affiliations
  • 1Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
  • 2Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
JAMA Ophthalmol. 2021;139(4):e210514. doi:10.1001/jamaophthalmol.2021.0514

A young adult presented with left-eye redness and pain, which was unresponsive to corticosteroids for presumed uveitis. The patient’s visual acuity was 20/50 OS, with thickened pink conjunctiva, corneal edema, and anterior chamber cell, hypopyon, and diffuse, white vascular iris infiltration. A history revealed B-cell acute lymphoblastic leukemia/lymphoma (B-ALL) in remission after a bone marrow transplant. No B-ALL recurrence or posttransplant lymphoproliferative disorder was identified via a bone marrow biopsy, blood work, and Epstein-Barr virus testing.1 Anterior segment fluorescein angiography (Figure, A) showed an area of maximal vascularity that guided a fine-needle biopsy. Histologic sections showed blasts in the iris, aqueous humor, and conjunctiva (Figure, B). Blasts were positive for terminal deoxynucleotidyl transferase and CD19, CD20, and CD22 immunoperoxidase stains, consistent with B-ALL.2 Systemic chemotherapy and ocular radiation were started.

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