title: Ophthalmic manifestations of relapsing acute childhood leukemia.
abstract: Acute lymphoblastic leukemia is the most common malignancy in children. We report 3 patients who presented to their general pediatricians and pediatric oncologists with ocular complaints as the only evidence of their leukemic relapses. All patients presented with persistent conjunctival injection and were referred to an ophthalmologist for further management. Two patients were diagnosed with recurrent anterior uveitis, which after extensive workup and treatment with topical glucocorticoids was found to be a result of leukemic ocular disease. One patient had a conjunctival tumor, which was biopsied and confirmed to be leukemic infiltration. All children eventually succumbed to their recurrent disease. These cases demonstrate the need for a high index of suspicion when evaluating ocular symptoms in patients with a prior history of acute lymphoblastic leukemia. Anterior chamber paracentesis and biopsy of suspicious lesions should be considered as possible diagnostic procedures in addition to standard hematologic studies. Collaboration between a primary care physician, pediatric oncologist, and ophthalmologist is essential for optimal diagnosis and treatment.
authors.affiliation: Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Isaac M
authors.initials: IM
authors.lastname: Chocron
authors.affiliation: Vanderbilt Eye Institute, Nashville, Tennessee; Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
authors.forename: David G
authors.initials: DG
authors.lastname: Morrison
authors.affiliation: Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee; Vanderbilt Ingram Cancer Center, Nashville, Tennessee.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Friedman
authors.affiliation: Vanderbilt University School of Medicine, Nashville, Tennessee; Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee. Electronic address: neerav.desai@vanderbilt.edu.
authors.forename: Neerav A
authors.initials: NA
authors.lastname: Desai
authors.affiliation: Vanderbilt Eye Institute, Nashville, Tennessee; Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Donahue
mesh_terms: D000293:Adolescent; D002648:Child; D003228:Conjunctiva / Q000473:pathology*; D005134:Eye Neoplasms / Q000175:diagnosis*; D017809:Fatal Outcome; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D017254:Leukemic Infiltration; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis*; D054218:Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis*; D014606:Uveitis, Anterior / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D005938:Glucocorticoids