case_images: PMC11802173_01
case_images: MRI image at two years and 10 months. (a) T2-weighted low-signal soft-tissue shadow is seen from the outer lateral wall of the left orbit to the temporal fossa and submental area of the temporal cortex. (b) The left optic nerve is enlarged. (c) The lesion extends along the optic nerve to the cavernous sinus.
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case_images: PMC11802173_01_cureus-0017-00000077094-i01.jpg
case_images: FIG1
case_images: At two years and 10 months of age, the patient presented with enlargement of extramedullary lesions, including those in the left orbit (Figure 1).
case_images: Fundus photographs at three years and 11 months. (a) The right eye is depicted and no discernible abnormalities were evident. (b) The left eye is illustrated and retinitis pigmentosa-like findings were apparent.
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case_images: FIG2
case_images: At three years and 11 months, retinitis pigmentosa-like findings, which is degeneration with pigment neopigmentation in the mid- to peripheral fundus, were observed (Figure 2).
case_images: Fundus photographs at four years and two months. Examination at four years and two months revealed moderately dilated left pupil and loss of light reflex. Fundus examination revealed optic nerve papillary swelling, dilated and tortuous retinal vessels, and serous retinal detachment.
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case_images: PMC11802173_01_cureus-0017-00000077094-i03.jpg
case_images: FIG3
case_images: These included moderate mydriasis with no light reflex in the left eye, optic disc swelling, tortuous and dilated retinal vessels, and serous retinal detachment, which were documented through fundus photography (Figure 3).
case_images: Ultrasonographic images at four years and two months. (a) and (b) both show thick, hyperintense findings under the retina (not partially but entirely). (Two images are shown to illustrate that the hyperintense findings are not partial, but rather are seen throughout the entirety of the lesion.)
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case_images: FIG4
case_images: Subsequent examinations revealed a thick, hyperreflective subretinal lesion visible on ultrasound and confirmed by ultrasound and PET-CT scans (Figures 4, 5).
case_images: MRI and PET-CT images at four years and two months. (a) and (b) demonstrate an elevated lesion and retinal detachment that are suspicious of leukaemic infiltration under the left retina. Additionally, (c) shows a banded fluorodeoxyglucose accumulation in the left retina, thereby strongly suggesting leukaemic retinal infiltration.
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case_images: FIG5
case_images: Subsequent examinations revealed a thick, hyperreflective subretinal lesion visible on ultrasound and confirmed by ultrasound and PET-CT scans (Figures 4, 5).
case_images: Fundus photograph after treatment (four years and three months). In the figure, (a) displays the image of the right eye, and no indications of retinitis pigmentosa were observed; (b) depicts the image of the left eye, wherein the retinal blood vessels exhibited cloudiness, and the serous retinal detachment dissipated. However, evidence suggestive of retinitis pigmentosa persisted, and proliferative alterations were evident.
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case_images: FIG6
case_images: Post-treatment observations at four years and three months showed resolution of the serous retinal detachment, although pigmentary and proliferative changes persisted, indicating residual disease activity (Figures 6, 7).
case_images: PET-CT and CT images after treatment (four years and three months). (a) PET-CT images showed that the fluorodeoxyglucose (FDG) accumulation in the left retina was obscured and considered to be a treatment effect. (b) CT images also showed no thickening lesions or detachment of the retina.
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case_images: PMC11802173_01_cureus-0017-00000077094-i07.jpg
case_images: FIG7
case_images: Post-treatment observations at four years and three months showed resolution of the serous retinal detachment, although pigmentary and proliferative changes persisted, indicating residual disease activity (Figures 6, 7).
case_images: Optical coherence tomography (OCT) image at four years and eight months. At four years and eight months, the right eye has no retinitis pigmentosa-like findings, but the optic nerve papilla is slightly pale and OCT shows intraretinal oedema. The cause of the inner layer oedema is unknown, but we are following her progress with caution. The patient has difficulty wearing glasses, and visual acuity tests have not been performed due to lack of cooperation.
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case_images: FIG8
case_images: The patient continued to have ocular abnormalities, including vascular whitening and optic disc pallor in the right eye, along with retinal oedema, as documented by OCT at four years and eight months (Figure 8).