Acute Lymphoblastic Leukaemia Revealed By Masquerade Syndrome

Uveitis Masquerade Syndromes are a group of eye diseases that can mimic chronic intraocular inflammation. They may be secondary to primary intraocular lymphomas, leukaemias, uveal melanoma, retinoblastoma, ocular metastases or paraneoplastic syndromes. We aim to show the importance of an haematological assessment in case of any uveitis.

We report the observation of a 5 years old child with hypertensive pseudo-uveitis revealing acute leukaemia.

Clinical records and multimodal imaging findings including fundus photography, fundus autofluorescence (FAF), fluorescein angiography (FA), optical coherence tomography (OCT) were analyzed. Also biological tests, chest x-ray and bone marrow biopsy were performed.

A 5 year old male child referred to emergency with eye pain, photophobia and acute decrease in visual acuity in left eye 7 days prior to admission.

On clinical examination, his visual acuity had collapsed to 2/10, corneal oedema, a 3-cross tyndal and hypopyon, as well as posterior synechiae. Ocular hypertonia was measured at 22mmHg, and the fundus was normal. A biological tests was performed, revealing pancytopenia. Bone marrow biopsy revealed an acute lymphoblastic leukaemia. The patient received intravenous chemotherapy with systemic corticosteroids, combined with local treatment including corticosteroids, intraocular pressure-lowering and cycloplegic drops. Clinical outcome was favourable with normalisation of his eye examination.

Correct diagnosis and treatment of pseudouveitis improves visual prognosis as well as the vital one and save lives.