title: Bilateral optic disk edema and blindness as initial presentation of acute lymphocytic leukemia.
abstract: OBJECTIVE
  To report bilateral optic disk edema and blindness as the unusual initial presentation of acute lymphocytic leukemia (ALL) in an adult.
  
  
  METHODS
  A 19-year-old man presented with a history of headaches, back pain, and 10 days of worsening vision that progressed to blindness. Ocular examination revealed light perception acuity in the right eye and no light perception in the left eye. Fundus examination revealed bilateral profound optic disk edema, tortuous vessels, and retinal hemorrhages. Acute lymphocytic leukemia was diagnosed with complete blood count and bone marrow biopsy. Head computed tomography and magnetic resonance imaging, were normal. Lumbar puncture revealed normal opening pressure. Ocular ultrasonography showed bilateral optic nerve enlargement.
  
  
  METHODS
  Interventional case report and literature review.
  
  
  RESULTS
  The presumptive diagnosis of leukemic infiltration of the optic nerves was made, and urgent radiotherapy, intrathecal methotrexate, and intravenous daunorubicin were instituted. Visual acuity improved to hand motions in the right eye.
  
  
  CONCLUSIONS
  Acute lymphocytic leukemia can rarely present in adults as visual changes due to leukemic optic nerve infiltration. Radiation treatment should be considered as an urgent treatment modality for this rare condition.
authors.affiliation: Department of Ophthalmology, University of Texas Health Science Center at San Antonio, 78229-3900, USA.
authors.forename: George L
authors.initials: GL
authors.lastname: Mayo
authors.forename: John E
authors.initials: JE
authors.lastname: Carter
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: McKinnon
mesh_terms: D000328:Adult; D001766:Blindness / Q000175:diagnosis*; D003937:Diagnosis, Differential; D006801:Humans; D006984:Hypertrophy; D008297:Male; D009900:Optic Nerve / Q000000981:diagnostic imaging / Q000473:pathology; D010211:Papilledema / Q000175:diagnosis*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis*; D012166:Retinal Hemorrhage / Q000175:diagnosis; D014463:Ultrasonography; D014792:Visual Acuity