English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Tools annual

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools monthly

Global: Zendy Plus monthly

Presents the access of premium content as premium feature

Premium Content

Global: Zendy Plus annual

Global: Zendy Free Plan

Dear Editor, W e report a case of significant exudative hemorrhagic retinopathy attributed to differentiation syndrome (DS). DS is a systemic inflammatory condition seen in patients with acute promyelocytic leukemia (APML) undergoing treatment with all-trans retinoic acid (ATRA). DS can lead to endothelial injury and capillary leakage throughout the body. Treatment with corticosteroids during chemotherapy has been shown to reduce the risk of developing DS. There are limited reports of the ocular manifestations of DS in the literature, including pale yellow choroidal lesions, scattered retinal hemorrhages, and serous retinal detachments. A 25-year-old male presented to the Emergency Department with two weeks of fatigue and intermittent bleeding from his nose and gums. A complete blood count demonstrated profound thrombocytopenia (platelet count of 5 k/μL, reference range 150-400 k/μL) and leukocytosis (white cell count of 22.4 k/μL, reference range 4.0-11.0 k/μL) with blasts. Hemoglobin was 10.5 g/dL (reference range 13.5-17.5 g/dL). A peripheral blood smear and bone marrow biopsy were consistent with APML [t(15;17)(q24;q21)/PML-RARA translocation]. He was admitted for standard treatment with ATRA, arsenic trioxide, and intravenous corticosteroids. An initial ophthalmology consult for bilateral blurring of vision demonstrated visual acuity of 20/30 in both eyes with scattered subretinal, intraretinal, and preretinal hemorrhages (Figure 1) consistent with typical leukemic retinopathy. Ten days later, shortly after cessation of intravenous steroids, he developed hypoxia, tachycardia, fever, and worsening vision in both eyes. Best corrected visual acuity at that point was 20/60 on the right and 20/200 on the left. Repeat funduscopic examination demonstrated significant worsening of his retinal hemorrhages with new-onset optic nerve swelling (Figure 2) and bilateral macular edema (Figure 3). Repeat labs demonstrated a white blood cell count of 0.7 k/μL, a platelet count of 28 k/μL, and hemoglobin of 7.8 g/dL. Serum viscosity was normal (viscosity level of 1.3 Centipoise, reference range 1.4-1.8 Centipoise). Fluorescein angiogram (FA; Figure 4) showed normal arteriovenous transit times with intact retinal perfusion and diffuse leakage from the optic nerves and retinal vessels. Magnetic resonance imaging (MRI) of the brain and orbits with contrast showed no leukemic

Exudative hemorrhagic retinopathy related to all-trans retinoic acid differentiation syndrome in a patient with acute promyelocytic leukemia