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© 2000 American Society for Clinical Oncology
Unusual Manifestations of Acute LeukemiaArthur Skarin MD Consultant Editor
Roswell Park Cancer Institute and Buffalo General Hospital, Buffalo, NY CASE 3. UNILATERAL LEUKEMIC HYPOPYON A 64-year-old man with acute lymphoblastic leukemia was treated with cyclophosphamide, daunorubicin, vincristine, and prednisone for induction chemotherapy per Cancer and Leukemia Group B trial 9911.1 He subsequently received intensification chemotherapy, CNS prophylaxis, late intensification, and prolonged maintenance according to that study. While receiving prolonged maintenance, he developed pain in his left eye, high intraocular pressure, hyperemia of the sclera, and a hypopyon (Fig 1, arrow, light-colored area). CSF evaluation revealed cytologic evidence of a leukemic relapse. Bone marrow aspiration and biopsy did not reveal any evidence of disease relapse. Intrathecal chemotherapy with methotrexate (15 mg), cytarabine (40 mg), and hydrocortisone (50 mg) along with the use of topical glaucoma and corticosteroid drops resulted in resolution of his pain, hyperemia, leukemic hypopyon, glaucoma, and CSF disease. This case demonstrates an example of a unilateral leukemic hypopyon presenting as the first sign of CNS relapse in an adult acute lymphoblastic leukemia patient.
Leukemic hypopyon refers to the presence of leukemic cells layered in the anterior chamber of the eye. Cytologic examination is the only way to make a definitive diagnosis. Topical therapy alone is not effective and treatment options include chemotherapy (systemic and intrathecal) and irradiation of the anterior chamber.2-5 The prognosis of this complication depends on whether it occurs during therapy or after therapy has been discontinued.5 The differential diagnoses of leukemic hypopyon include infectious6,7 and inflammatory8-10 causes as well the use of rifabutin for treatment and prophylaxis of Mycobacterium avium complex infection.11 Copyright 2000 American Society of Clinical Oncology REFERENCES
1.
Larson RA, Dodge RK, Linker CA, et al: A randomized controlled trial of filgrastim during remission induction and consolidation chemotherapy for adults with acute lymphoblastic leukemia: CALGB study 9111. Blood 92: 1556-1564, 1998 2. Bunin N, Rivera G, Goode F, et al: Ocular relapse in the anterior chamber in childhood acute lymphoblastic leukemia. J Clin Oncol 5: 299-303, 1987[Abstract] 3. Ayliffe W, Foster CS, Marcoux P, et al: Relapsing acute myeloid leukemia manifesting as hypopyon uveitis. Am J Ophthalmol 119: 361-364, 1995[Medline] 4. Decker EB, Burnstine RA: Leukemic relapse presenting as acute unilateral hypopyon in acute lymphocytic leukemia. Ann Ophthalmol 25: 346-349, 1993[Medline] 5. Smith WS, Burke MJ, Wong KY: Hypopyon in acute lymphoblastic leukemia. Med Pediatr Oncol 12: 258-259, 1984 [Medline]
6.
Recchia FM, Baumal CR, Sivalingam A, et al: Endophthalmitis after pediatric strabismus surgery. Arch Ophthalmol 118: 939-944, 2000 7. Sridhar MS, Garg P, Bansal AK, et al: Aspergillus flavus keratitis after laser in situ keratomileusis. Am J Ophthalmol 129: 802-804, 2000[Medline] 8. Nussenblatt RB: Uveitis in Behcet’s disease. Int Rev Immunol 14: 67-79, 1997[Medline] 9. Iijima S, Iwata M, Otsuka F: Psoriatic arthritis and hypopyon-iridocyclitis: Possible mechanism of the association of psoriasis and anterior uveitis. Dermatology 193: 295-299, 1996[Medline] 10. Dodds EM, Lowder CY, Meisler DM: Posterior segment inflammation in HLA-B27+ acute anterior uveitis: Clinical characteristics. Ocul Immunol Inflamm 7: 85-92, 1999[Medline] 11. Petrowski JT III: Uveitis associated with rifabutin therapy: A clinical alert. J Am Optom Assoc 67:693-696, 1996
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Copyright © 2000 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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