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Ophthalmology and Visual Sciences

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Leukemic pseudohypopyon

Category(ies): Uveitis, Retina/Vitreous

Photographer: Sarah L. Skiles, CRA

Contributor(s): Lauren E. Hock, MD; James C. Folk, MD

Posted April 17, 2019

Pseudohypopyon is a relatively rare manifestation of leukemia. It occurs most often in patients with acute lymphoblastic leukemia and may be seen during a blast crisis or as a sign of relapse [1]. Rapid development of an atypical, blood-stained hypopyon that fails to respond to corticosteroid therapy is classic for leukemic pseudohypopyon [2]. Pseudohypopyon is distinguished from infectious or inflammatory hypopyon by the absence of an associated fibrin reaction. This pseudohypopyon was the first sign of this 56-year-old patient's acute lymphoblastic leukemia relapse. Timely anterior chamber aspiration with cytology and systemic malignancy work-up are paramount to ensuring appropriate diagnosis and treatment.

See related atlas entry: Leukemic retinopathy

Slit lamp photograph of the left eye shows mild injection, clear cornea, and presence of a 3.5 mm blood-tinged pseudohypopyon in the anterior chamber with 4+ fine cell and no fibrin. Leukemic pseudohypoyon may present bilaterally, but this patient's right eye was unaffected.

Figure 1. Slit lamp photograph of the left eye shows mild injection, clear cornea, and presence of a 3.5 mm blood-tinged pseudohypopyon in the anterior chamber with 4+ fine cell and no fibrin. Leukemic pseudohypoyon may present bilaterally, but this patient's right eye was unaffected.

Slit lamp photograph of the iris of the left eye highlights the presence of gelatinous fibrovascular lesions along the pupillary margin and peripheral iris.

Figure 2. Slit lamp photograph of the iris of the left eye highlights the presence of gelatinous fibrovascular lesions along the pupillary margin and peripheral iris.

Reference(s)

  1. Yi, D.H., et al., Acute unilateral leukemic hypopyon in an adult with relapsing acute lymphoblastic leukemia. Am J Ophthalmol, 2005. 139(4): p. 719-21.
  2. Ramsay, A. and S. Lightman, Hypopyon uveitis. Surv Ophthalmol, 2001. 46(1): p. 1-18.

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last updated: 04/17/2019
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