Bilateral optic disc infiltration in relapse of acute lymphoblastic leukemia.

A six-year-old female who was a diagnosed case of acute lymphoblastic leukemia (ALL) presented with painless and progressive vision loss in both eyes (OU) for 15 days. The patient was on Berlin-Frankfurt-Munich 2002 protocol chemotherapy for the past one year, with the last cycle taken two months ago. Visual acuity was nil perception of light OU and pupils were non-reactive. Anterior segment was essentially normal OU while fundus examination revealed modified Frisen’s[1] grade 3 disc edema with peripapillary hemorrhages and macular exudates OU [Fig. 1a and b]. Brain imaging showed normal results. Ocular involvement in ALL is rare, but optic nerve involvement as the first sign of relapse or recurrence has been described.[234]

Figure 1

(a and b) Modified Frisen’s grade 3 disc edema with peripapillary hemorrhages and exudates in the central macular region

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