Diplopia as the presenting feature of acute lymphoblastic leukemia

Abstract

Purpose: To report a rare case of acute lymphoblastic leukemia presenting with diplopia to an ophthalmologist. Observations: A 29-year-old male patient presented to ophthalmology department with sudden onset of binocular diplopia in left gaze. Magnetic resonance imaging of brain and orbits revealed a thickened left medial rectus, with enhancement of right sixth nerve, bilateral third and fifth nerves. Bone marrow biopsy revealed acute lymphoblastic leukemia (ALL) with a Burkitt-type chromosomal translocation—t(8; 14) and the patient was started on chemotherapy. Conclusion and importance: This was a case of incomitant esotropia worse with left gaze due to left medial rectus infiltration mimicking a left sixth cranial nerve paresis. Diplopia can be the only presenting symptom of ALL and it can involve either an extraocular muscle or a cranial nerve.

Keywords

• Acute lymphoblastic leukemia
• Sixth nerve palsy
• Extraocular muscle infiltration