GUO Qing, HUANG Hou-bin, PI Yu-li and LIU Tian-xing

      Isolated extramedullary ocular relapse of acute lymphoblastic leukemia (ALL) after allogeneic peripheral blood stem cell transplantation (allo-PBSCT) without concomitant involvement of the bone marrow is very rare,while the common sites of extramedullary relapse are the central nervous system, skin, bone, and breasts.1 This is the report of isolated ocular relapse without any extra-ocular involvement of ALL after allo-PBSCT confirmed by histopathology.
      A 30-year-old man with ALL in complete remission was admitted to our hospital due to blurred vision of the right eye. Six months before, he underwent an allo-PBSCT from his HLA-identical brother. His best-corrected visual acuity in the right eye was 20/200 and 20/20 in the left eye. Fundus examination revealed a bullous exudative retinal detachment (ERD) in the inferior portion of the right eye (Figure 1A).
      Systemic examination, the peripheral blood, and bone marrow showed no evidence of relapse of ALL. Lumbar puncture and magnetic resonance imaging showed no involvement of the central nervous system. The patient was treated with methylprednisolone (1000 mg daily for 3 days) and prednisone (60 mg daily for 5 days; the dose was tapered by 5 mg every 5 days) for presumed noninfectious panuveitis. ERD completely resolved 7 days after corticosteroids treatment, and the visual acuity of the right eye recovered to 20/20. However, ERD recurred 2 months after corticosteroids treatment. Laboratory examinations showed cytomegalovirus IgM (−), toxoplasma IgM antibodies (−), and herpes simplex virus IgM antibodies (−). A computed tomography scan of the orbit was normal.