title: Peripheral ulcerative keratitis with bilateral optic nerve involvement as an initial presentation of acute lymphocytic leukemia in an adult.
abstract: BACKGROUND
  To report a case of peripheral ulcerative keratitis (PUK) and scleritis, along with bilateral optic nerve infiltration as an initial presentation of acute lymphocytic leukemia (ALL) in an adult.
  
  
  METHODS
  Observational case report.
  
  
  METHODS
  A 24-year-old patient presented with complaints of pain, redness, and watering in the right eye since 15 days along with progressive decrease of vision since 3 months, leading to bilateral blindness. On examination, the visual acuity was absence of light perception in both eyes. Examination of the right eye revealed a PUK and adjacent localized scleritis. Fundus examination revealed bilateral multiple flame-shaped retinal haemorrhages. The optic discs in both eyes showed pallor with blurred margins. B-scan ultrasonography revealed bilateral optic nerve thickening. Head computed tomography was normal. Blood picture and bone marrow examination revealed features consistent with ALL. For sclerokeratitis, the patient was recommended topical steroids along with adjuvant therapy. She was referred to the oncology services for management of leukemia and was treated with chemotherapy.
  
  
  RESULTS
  The sclerokeratitis responded well to medical management. However, no gain in vision could be achieved.
  
  
  CONCLUSIONS
  ALL can present with sclerokeratitis and bilateral blindness due to optic nerve infiltration in an adult. Early diagnosis and prompt management may save the patient from blindness.
authors.affiliation: Dr. Rajendra Prasad Centre For Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India. bhavna2424@hotmail.com
authors.forename: Bhavna
authors.initials: B
authors.lastname: Chawla
authors.forename: Prakashchand
authors.initials: P
authors.lastname: Agarwal
authors.forename: Radhika
authors.initials: R
authors.lastname: Tandon
authors.forename: Jeewan S
authors.initials: JS
authors.lastname: Titiyal
mesh_terms: D000328:Adult; D003320:Corneal Ulcer / Q000175:diagnosis* / Q000188:drug therapy; D004359:Drug Therapy, Combination; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use; D000077734:Gatifloxacin; D006801:Humans; D007429:Intraocular Pressure; D054327:Lubricants / Q000627:therapeutic use; D009901:Optic Nerve Diseases / Q000175:diagnosis* / Q000188:drug therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis*; D011239:Prednisolone / Q000031:analogs & derivatives / Q000627:therapeutic use; D012166:Retinal Hemorrhage / Q000175:diagnosis; D015423:Scleritis / Q000175:diagnosis* / Q000188:drug therapy; D014326:Tropanes / Q000627:therapeutic use
chemical_list: D024841:Fluoroquinolones; D054327:Lubricants; D014326:Tropanes; C009935:prednisolone acetate; C100236:homatropine; D011239:Prednisolone; D000077734:Gatifloxacin