Abstract Ref Number = APCP888
OPTIC NERVE SWELLING AND RETINOPATHY LEUKEMIA IN A 8th YEARS OLD BOYS WITH ACUTE LYMPHOBLASTIC LEUKEMIC CNS ISOLATED RELAPSE
Sri Wahyuni Djoko,Ketut Ariawati,Wayan Eka Sutyawan
Medical School Of Udayana University Department of Child Health Department of Ophtalmology
Background : Acute lymphoblastic leukemia is malignancy in hematology. Optic nerve swelling usually happens in relapse condition and associated with poor prognosis. Prognosis is strongly correlated to age at diagnosis, but natural history remains poorly understood until present. Leukemia can persist any organ in the body including the eye. Isolated optic nerve infiltration by leukemic cells has rarely been reported as an initial presentation of disease recurrence.
Case Presentation Summary : We present a case of 8-years-old boy with a history of T- cell acute lymphoblastic leukemia. He was treated with high risk protocol of lymphoblastic leukemia about ten month, before came with fever, malaise, and cephalgia again, we changed protocol to CNS Isolated Relapse–ALL Chemotherapy Protocol. After two months treated, he got relapsed for the second time. He came with blurred vision, from the physical examination we found, right eye was still normal, while left eye revealed a fluffy white mass obscuring the optic disc with peripapillary vascular sheathing with papillary oedem, and roth’s spot. MRI showed normal optic nerves on right eye, left eye demonstrates non enhancing mass covering the optic disc
Learning Points/Discussion : ALL Isolated relapse with optic disc swelling is a rare case. Incidence of isolated or combined CNS relapse significantly decreased and unilateral optic nerve infiltration as an initial site of relapse in second ALL remission is a rare manifestation. We report a 8th years-old boy with, CNS isolated relapse, hyperleukocytosis and unilateral optic disc swelling, two month after treated with ALL Isolated relapse protocol, at maintenance phase. Infection is a complication that aggravate disease management
Keywords: acute lymphoblastic leukemia relapse phase retinopathy leukemia. optic nerve swelling