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A Chronic Lymphocytic Leukemia Case Presenting with Postpartum Bilateral Central Retinal Vein Occlusion

Year 2021, Volume: 4 Issue: 1, 65 - 70, 18.09.2021

Abstract

Purpose: We aimed to report a case who presented with low vision in both eyes in the postpartum period, bilateral central retinal vein occlusion was detected in ophthalmological examination and then chronic lymphocytic leukemia has been diagnosed and died shortly after diagnosis.
Case Presentation: A 37-year-old female patient, who had a healthy third parturition by cesarean, admitted to our clinic with new onset of vision loss in both eyes 40 days after birth. Visual acuity of the patient was 20/200 in the right eye and 20/100 in the left eye. Fundus examination revealed retinal hemorrhages, exudations and tortuosity in the retinal vessels in 4 quadrants in both eyes. Bilateral central retinal vein occlusion was diagnosed. Hematology consultation was requested. Systemic examination revealed fever and hepatosplenomegaly. Thoracic tomography and abdominal ultrasonography of the patient revealed lymphadenopathy in the mediastinum, portal hilus, bilateral supraclavicular and axillary regions. In patient’s hemogram, first leukocytosis and then leukopenia but always lymphocytosis, anemia and thrombocytopenia was present. It was thought to be chronic lymphocytic leukemia by performing peripheral smear. Patient’s health condition worsened during this period and she was admitted to the anesthesiology and reanimation intensive care unit. It was learned that first she had pneumonia and then died due to cardiac arrest in intensive care unit.
Conclusion: A young patient admitted to the hospital with postpartum vision loss died shortly after chronic lymphocytic leukemia diagnosis. Although puerperal or systemic thromboembolic conditions are considered in the case of postnatal retinal vein occlusion, it should be kept in mind that there may be more serious underlying diseases.

References

  • 1. Cugati S, Wang JJ, Rochtchina E, Mitchell P. Ten-year incidenceof retinal vein occlusion in an older population: the BlueMountains Eye Study. Arch Ophthalmol. 2006;124(5):726–32.
  • 2. Tomasini DN, Segu B. Systemic considerations in bilateral central retinal vein occlusion. Optometry 2007;78:402– 8.
  • 3. Tseng MY, Chen YC, Lin YY, Chu SJ, Tsai SH. Simultaneous bilateral central retinal vein occlusion as the initial presentation of acute myeloid leukemia. Am J Med Sci. 2010 Apr;339(4):387-9.
  • 4. Loh MA, Abirami S, Chong MF. Bilateral central retinal vein occlusion in a pregnant lady. Med J Malaysia. 2017 Apr;72(2):130-132.
  • 5. Kammoun S, Kilani W, Abid F, Ben Amor S, Feki J. Bilateral simultaneous central retinal vein occlusion revealing Waldenström's macroglobulinemia. Presse Med. 2019 Feb;48(2):201-206.
  • 6. Uhr JH, Thau A, Chung C, Zhang XC. Rare Presentation of Bilateral Central Retinal Vein Occlusion and Leukemic Retinopathy in a Young Adult Diagnosed with T-cell Acute Lymphoblastic Leukemia. Cureus. 2020 Jan 15;12(1):e6666.
  • 7. Bucciarelli P, Passamonti SM, Gianniello F, Artoni A, Martinelli I. Thrombophilic and cardiovascular risk factors for retinal vein occlusion. Eur J Intern Med. 2017 Oct;44:44-48.
  • 8. Hernández JL, Sanlés I, Pérez-Montes R, Martínez-Taboada VM, Olmos JM, Salmón Z, Sierra I, Escalante E, Napal JJ. Antiphospholipid syndrome and antiphospholipid antibody profile in patients with retinal vein occlusion. Thromb Res. 2020 Jun;190:63-68.
  • 9. Schachat AP, Markowitz JA, Guyer DR, Burke PJ, Karp JE, Graham ML. Ophthalmic manifestations of leukemia. Arch Ophthalmol. 1989;107:697–700.

Postpartum Bilateral Santral Retinal Ven Oklüzyonu ile Başvuran Bir Kronik Lenfositik Lösemi Olgusu

Year 2021, Volume: 4 Issue: 1, 65 - 70, 18.09.2021

Abstract

Amaç: Postpartum dönemde her iki gözde az görme şikayetiyle başvuran, bilateral santral retinal ven oklüzyonu tespit edilen, daha sonra kronik lenfosittik lösemi tanısı alan ve tanıdan kısa bir süre sonra exitus olan bir hastanın sunulması amaçlanmıştır.
Olgu Sunumu: Sezaryenle sağlıklı üçüncü canlı doğumunu yapan 37 yaşında kadın hasta, doğumundan 40 gün sonra her iki gözde yeni başlayan görme azlığı nedeniyle kliniğimize başvurdu. Hastanın yapılan muayenesinde görme keskinliği sağ gözde 20/200, sol gözde 20/100 idi. Fundus muayenesinde her iki gözde 4 kadranda retinal hemorajiler, eksudasyonlar ve retinal damarlarda tortiozite olduğu görüldü. Hastaya bilateral santral retinal ven oklüzyonu tanısı kondu. Hasta hematolojiye konsulte edildi, yapılan sistemik muayenesinde ateşi ve hepatosplenomegalisi olduğu saptandı. Hastanın yapılan toraks tomografisi ve tüm batın ultrasonografisinde mediasten, portal hilus, bilateral supraklavikuler ve aksiller bölgelerde lenfadenopatisi olduğu saptandı. Hemogramında önce lökositoz ardından lökopeni tespit edilen ve her iki durumda da lenfositoz, anemi ve trombositopenisi olan hastaya periferik yayma yapılarak kronik lenfositik lösemi düşünüldüğü, bu süreçte durumu kötüleşen hastanın anesteziyoloji ve reanimasyon yoğun bakım ünitesine yatırıldığı, yoğun bakımda önce pnömoni ardından kardiyak arrest gelişerek exitus olduğu öğrenildi.
Sonuç: Hastaneye postpartum görme azlığı ile başvuran genç bir hasta kronik lenfositik lösemi tanısı aldıktan kısa bir süre sonra hayatını kaybetmiştir. Doğum sonrası gelişen retinal ven oklüzyonu durumunda puerperal veya sistenik tromboembolik durumlar ön planda düşünülse de, altta yatan daha ciddi hastalıklar olabileceği akılda tutulmalıdır.

References

  • 1. Cugati S, Wang JJ, Rochtchina E, Mitchell P. Ten-year incidenceof retinal vein occlusion in an older population: the BlueMountains Eye Study. Arch Ophthalmol. 2006;124(5):726–32.
  • 2. Tomasini DN, Segu B. Systemic considerations in bilateral central retinal vein occlusion. Optometry 2007;78:402– 8.
  • 3. Tseng MY, Chen YC, Lin YY, Chu SJ, Tsai SH. Simultaneous bilateral central retinal vein occlusion as the initial presentation of acute myeloid leukemia. Am J Med Sci. 2010 Apr;339(4):387-9.
  • 4. Loh MA, Abirami S, Chong MF. Bilateral central retinal vein occlusion in a pregnant lady. Med J Malaysia. 2017 Apr;72(2):130-132.
  • 5. Kammoun S, Kilani W, Abid F, Ben Amor S, Feki J. Bilateral simultaneous central retinal vein occlusion revealing Waldenström's macroglobulinemia. Presse Med. 2019 Feb;48(2):201-206.
  • 6. Uhr JH, Thau A, Chung C, Zhang XC. Rare Presentation of Bilateral Central Retinal Vein Occlusion and Leukemic Retinopathy in a Young Adult Diagnosed with T-cell Acute Lymphoblastic Leukemia. Cureus. 2020 Jan 15;12(1):e6666.
  • 7. Bucciarelli P, Passamonti SM, Gianniello F, Artoni A, Martinelli I. Thrombophilic and cardiovascular risk factors for retinal vein occlusion. Eur J Intern Med. 2017 Oct;44:44-48.
  • 8. Hernández JL, Sanlés I, Pérez-Montes R, Martínez-Taboada VM, Olmos JM, Salmón Z, Sierra I, Escalante E, Napal JJ. Antiphospholipid syndrome and antiphospholipid antibody profile in patients with retinal vein occlusion. Thromb Res. 2020 Jun;190:63-68.
  • 9. Schachat AP, Markowitz JA, Guyer DR, Burke PJ, Karp JE, Graham ML. Ophthalmic manifestations of leukemia. Arch Ophthalmol. 1989;107:697–700.
There are 9 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Articles
Authors

Kamil Yavuzer 0000-0002-2165-317X

Beyza Yavuzer This is me 0000-0002-9907-1997

Ali Meşen 0000-0002-0361-9066

Publication Date September 18, 2021
Submission Date November 1, 2020
Published in Issue Year 2021 Volume: 4 Issue: 1

Cite

Vancouver Yavuzer K, Yavuzer B, Meşen A. Postpartum Bilateral Santral Retinal Ven Oklüzyonu ile Başvuran Bir Kronik Lenfositik Lösemi Olgusu. MRR. 2021;4(1):65-70.