BILATERAL INFILTRATIVE OPTIC NEUROPATHY IN RELAPSED LYMPHORETICULAR MALIGNANCIES - A CASE SERIES

Abstract

Background: Leukaemic or lymphomatous infiltration of the optic nerve is a rare, but severe neuro-ophthalmology condition. Its diagnosis is often confused with either optic neuropathy due to infection, inflammation, optic nerve compression or side effect of chemotherapy or radiotherapy itself.

Case Series: In our series, there were four cases with bilateral infiltrative optic neuropathy secondary to lymphoreticular malignancies. Their ages ranged from 17 to 49 years of age. Two were male and two were female. Two patients had non-Hodgkin lymphoma, one had Hodgkin lymphoma (HL) and one had B-cell acute lymphoblastic leukaemia (B-ALL). All patients presented with acute reduced vision. Three cases also had diplopia and symptoms of increased intracranial pressure symptoms. Visual acuity upon presentation ranged from 6/6 to counting fingers. All cases had bilateral optic nerve swelling. Computed tomography (CT) scan in all patients showed optic nerve involvement. Two patients had obvious intracranial lesions, one patient with hydrocephalus only, while one patient had intraorbital lesion, with no intracranial involvement. All patients received chemotherapy. Three patients with central nervous system lymphoma had poor outcome. One patient with intraorbital involvement, survived.

Conclusion: Optic nerve infiltrations by lymphoreticular malignancies are rare. During disease recurrence or relapse, optic nerve involvement may be the first or only presenting feature. Thus, a high index of suspicion and early neuroimaging studies are important to assist in the diagnosis. In our review, optic nerve infiltration with CNS involvement has poor prognosis.

Keywords: Infiltrative optic neuropathy, lymphoreticular malignancy