Leukemic Retinopathy Mimicking Cytomegalic Virus Retinitis Ending in Total Blindness from Tumor Lysis Following Local Corticosteroid and Salvage Chemotherapy

Authors present a 15-year-old adolescent who recently received chemotherapy for T-cell acute lymphoblastic leukemia. The bilateral visual decrease resulted from diffuse superficial perivascular hemorrhages. The clinical impression was cytomegalovirus retinitis. The patient did not respond to antiviral therapy and polymerase chain reaction for cytomegalovirus in the blood was negative. Two weeks later, the hemorrhages have started to fade revealing diffuse perivascular creamy subretinal infiltrates by fundoscopy and OCT. Following salvage chemotherapy and subtenon corticosteroid, subretinal infiltrates decreased markedly, the subretinal fluid in the macular region resolved and vision improved bilaterally. Optic disc swelling increased and two days after a second periocular corticosteroid, visual acuity dropped from CF near the face and 20/200 to NLP bilaterally with marked resolution of the retinal and disc tumor. The tumor regression resulted from autoinfarction with vascular compromise or treatment induced tumor lysis. two weeks later, the patient succumbed.