Images in Clinical Medicine

Retinal Hemorrhages in Acute Leukemia

Michael J. Leach, M.B., Ch.B.

N Engl J Med 2002; 346:e6June 6, 2002

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Figure 1 A 26-year-old man presented with acute myeloid leukemia (French–American–British stage M1) in January 1996. The leukemic blasts showed complex cytogenetic abnormalities, including a 3q26 break point, an abnormality that is often associated with refractory disease. The patient had no response to induction therapies, and he received palliative outpatient treatment. In December 1996, cranial-nerve palsies and a cough-associated headache developed. Leukemic blasts were present in the cerebrospinal fluid. In April 1997, central vision in his right eye deteriorated. Ophthalmoscopy showed not only multiple retinal hemorrhages and classic Roth's spots (thin arrow), but also a buffy coat in the large subhyaloid hemorrhage over the macula (thick arrow). The white-cell count was 195,000 per cubic millimeter (99 percent blasts), and the platelet count was 20,000 per cubic millimeter. The patient died in August 1997 after a massive intracerebral hemorrhage.

Michael J. Leach, M.B., Ch.B.
North Glasgow University Hospitals NHS Trust, Glasgow G21 3UW, United Kingdom

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