No PL in APL: No Perception of Light in Acute Promyelocytic leukemia

Abstract

Background: Acute promyelocytic leukemia (APL) is a distinct subtype of acute myeloid leukemia with a favorable prognosis. Hemorrhagic manifestations in APL at presentation are usually due to thrombocytopenia, consumptive coagulopathy, and fibrinolysis. Central nervous system (CNS) hemorrhage carries a risk for CNS relapse and early death in APL patients. Case Presentation: A 23-year-old male presented with sudden bilateral visual loss and headache. The ocular examination revealed a massive exudative retinal detachment in the right eye and bilateral dense vitreous hemorrhage. APL diagnosis was confirmed through peripheral blood and bone marrow examination, along with cytogenetic and molecular testing. The patient received 7+3 induction chemotherapy combined with All-trans-retinoic acid. After achieving complete remission, he underwent pars plana vitrectomy and silicone oil injection in the right eye. Intrathecal chemotherapy was considered for CNS prophylaxis after induction. Later, he had a medullary relapse which was managed with salvage therapy and autologous stem cell transplantation. Conclusion: Although APL has a favorable prognosis, its management can be complicated. It may present with retinal detachment or intraocular hemorrhage. Managing intraocular and intracranial hemorrhage is challenging due to the risks of hemorrhage and coagulopathy. This complexity is further heightened by poor visual prognosis, high risk of CNS infiltration, and potential for medullary relapse.