An 18-year-old male with a personal history of LLA-T in complete remission for 6 months after chemotherapy according to the PETHEMA LAL protocol - high risk/2003 (Vincristine, daunorubicin VA, prednisone plus intrathecal chemotherapy) and prednisone plus eye drops
Upon examination of the eye fundus (FO), a massive bilateral disc edema was observed.
The rest of the exploration was normal.
1.
Although other diseases were included in the differential diagnosis, such as hypertension, diabetes, intracranial mass, benign intracranial hypertension, bilateral optic neuritis or sarcoidosis, among others (2), due to the patient's age and, mainly, to his personal pathological antecedents,
The rest of the examinations were normal: normal magnetic resonance imaging (MRI), negative viral serology, negative lumbar puncture, no relapse in the blood count.
Although neuromeningeal discomfort was not observed, additional doses of intrathecal chemotherapy (CT) were administered.
The appearance of the FO improved, with less pronounced optic disc edema.
During admission, the patient suffered numerous complications, such as bronchopneumonia, adult respiratory distress syndrome, solitary hematoma and pseudotumor cer, and neck distress had to be managed.
1.
Six weeks after discharge, a new FO examination was performed due to worsening of visual symptoms, exudative retinal detachment in the RE with bilateral disc edema.
At that time, the blood count showed peripheral leukocytosis with blastosis, and the marrow aspirate showed a massive LAL-T.
1.
The patient received corticoid and QT treatment (Hyper CVAD protocol B phase and intrathecal therapy), showing successive gains and losses of VA.
Radiotherapy was not administered (2.4), since it is not included in the protocol used by our hospital for the treatment of T-ALL relapses.
Despite chemotherapy, no new remission of the disease was achieved, and the patient died a few months later.
