Bilateral Tumor Infiltration of the Optic Nerve in a Patient with Acute Lymphoblastic Leukemia (ALL) with Central Nervous System (CNS) Involvement: Case Report

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Alma Rosa Flores Rivera
Emmanuel Contreras Ortega
Oscar David Sanchez Ibarra

Abstract

Leukemic infiltration of the optic nerve is a rare but serious manifestation of acute lymphoblastic leukemia (ALL), particularly when involving the central nervous system (CNS). We report the case of a 23-year-old woman with a history of ALL in remission who presented with binocular diplopia, vertigo, and a central scotoma. Ophthalmic examination revealed bilateral optic disc edema, and cerebrospinal fluid analysis confirmed CNS relapse. The patient underwent intrathecal chemotherapy with subsequent improvement in visual function and reduction of optic nerve infiltration. This case underscores the importance of prompt recognition of visual symptoms in ALL survivors, as they may signal CNS involvement requiring urgent intervention.

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How to Cite
Flores Rivera, Alma Rosa, Emmanuel Contreras Ortega, and Oscar David Sanchez Ibarra. 2025. “Bilateral Tumor Infiltration of the Optic Nerve in a Patient With Acute Lymphoblastic Leukemia (ALL) With Central Nervous System (CNS) Involvement: Case Report”. International Journal of Medical Science and Clinical Research Studies 5 (09):1555-58. https://doi.org/10.47191/ijmscrs/v5-i09-10.
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References

I. Pui C-H, Robison LL, Look AT. Acute lymphoblastic leukaemia. Lancet.

;371(9617):1030-43.

II. Wang Y, Zhu L, Wang H, Li Z, Bai R, Wei Q, et al. Bilateral optic nerve infiltration and leukemic retinopathy as initial signs of leukemia relapse with central nervous system involvement in an adult: a case report. BMC Ophthalmol. 2024;24(1):225. doi:10.1186/s12886-024-03486-7.

III. Dini G, Capolsini I, Cerri C, Massei MS, Mastrodicasa E, Perruccio K, et al. Acute lymphoblastic leukemia relapse presenting with optic nerve infiltration. SAGE Open Med Case Rep. 2023;11:2050313X231175020. doi:10.1177/2050313X231175020.

IV. Reddy SC, Jackson N, Menon BS. Ocular involvement in leukemia—a study of 288 cases. Oman J Ophthalmol. 2013;6(1):19–23.

V. Russo V, Scott IU, Querques G, Iaccheri B, Cennamo G, Dell’Omo R, et al. Orbital and ocular manifestations of acute childhood leukemia: clinical and statistical analysis of 180 patients. Eur J Ophthalmol. 2008;18(4):619-23.

VI. Azad SV, Banerjee M, Parmanand K, Venkatesh P. Isolated optic nerve involvement in acute lymphoblastic leukaemia: a red flag for early relapse. BMJ Case Rep. 2021;14(6):e243689. doi:10.1136/bcr-2021-243689.

VII. Ra YH, Park SY, Im SA, Kim JY, Chung NG, Cho B. Enhancement of optic nerve in leukemic patients: leukemic infiltration of optic nerve versus optic neuritis. Investig Magn Reson Imaging. 2016 Sep;20(3):167–174. doi:10.13104/imri.2016.20.3.167

VIII. Xu F, Wu Y, Pan Y. Leukemic occult infiltrative optic neuropathy presenting as optic neuritis: a case report. BMC Ophthalmol. 2024;24(1):445. doi:10.1186/s12886-024-03717-x

IX. Myers KA, Nikolic A, Romanchuk K, Weis E, et al. Optic neuropathy in the context of leukemia or lymphoma: Diagnostic approach to a neuro-oncologic emergency. Neurooncol Pract. 2017 Mar;4(1):60–66. doi:10.1093/nop/npw006.

X. Nagpal MP, Mehrotra NS, Mehta RC, Shukla CK. Leukemic optic nerve infiltration in a patient with acute lymphoblastic leukemia. Retin Cases Brief Rep. 2016 Spring;10(2):127–130.

doi:10.1097/ICB.0000000000000187.

XI. da Costa DR, Fernandes RD, Susanna FN, da Silva Neto ED, Monteiro MLR. Complete reversal of bilateral optic nerve infiltration from lymphoblastic leukemia using chemotherapy without adjuvant radiotherapy. BMC Ophthalmol. 2021 Sep 15;21:335. doi:10.1186/s12886-021-02097-w.

XII. Bouladi M, Zerei N, Bouraoui R, El Matri L. Unilateral infiltration of the optic nerve revealing relapse of an acute lymphoblastic leukemia. Tunis Med. 2019 Mar;97(3):504–507. PubMed PMID: 31729727.