Article
Hyperviscosity syndrome and atypical retinal infiltrates associated with chronic lymphatic leukaemia
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Published: | September 22, 2004 |
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Outline
Text
Objective
A 22-year-old female patient in the 30th week of gestation of her first pregnancy, was referred with the suspected diagnosis of hyperviscosity syndrome for ophthalmological treatment and cardiovascular investigation. The patient complained of central visual loss in her left eye.
Methods
The following investigations were performed: visual acuity, tonometry, perimetry, amsler-chart-test, fundoscopy, photo-documentation, gynaecological and medical referral. The patient was followed-up for 10 months.
Results
Best visual acuity was 0.5 (left eye) and 1.0 (right eye). Amsler grid re-vealed metamorphopsia of the left eye. The anterior segments of the eye were normal including a transparent cornea and lens. Fundoscopy showed panretinal tortuosity, congestion of retinal vessels, small haemorrhages and white, irregular retinal areas were found next to the vessels and centrally. Submandibular and cervical lymph nodes were swollen. A full blood count revealed a leucocytosis and a left shift of the white blood cells due to chronic lymphatic leukaemia. The first line treatment was leucophoresis, so that the foetus was not endangered. After the normal birth of a healthy child, chemotherapy was commenced. After ten months of treatment there was evidence of paravascular focal pigment epitheliopathy, but no other abnormalities.
Conclusions
Our case-report outlines the importance of complex differential diagnoses in patients with congestion of retinal vessels. This should include haematological pathology, as it may be an unusual presentation even in an other-wise healthy young patient.