Work

Central nervous system relapse with optic nerve infiltration and meningeal involvement in B-cell acute lymphoblastic leukemia

Year: 2026

Type: article

Abstract: Leukemic infiltration of the optic nerves is an uncommon yet clinically significant manifestation of central nervous system (CNS) involvement in acute lymphoblastic leukemia (ALL). We report an adult male with B-cell ALL who developed progressive bilateral visual loss due to optic nerve infiltration and meningeal involvement, representing CNS relapse. The patient had been previously diagnosed with B-cell ALL and had discontinued therapy after induction chemotherapy. Several months later, he presented with bilateral visual loss and pain on eye movements. Ophthalmologic examination revealed bilateral optic disc edema. Magnetic resonance imaging of the brain and orbits demonstrated bilateral optic nerve thickening with postcontrast enhancement and associated leptomeningeal enhancement. Cerebrospinal fluid analysis confirmed malignant lymphoid cells, establishing CNS relapse. The patient was restarted on CNSdirected chemotherapy with partial visual improvement. This case highlights the optic nerve as a pharmacologic sanctuary site, emphasizes the importance of dedicated orbital imaging in patients with suspected CNS leukemia, and underscores the need for strict treatment compliance and long-term surveillance in ALL.

Source: Case Reports in Clinical Radiology

DOI: 10.25259/crcr_173_2025

Authors: Shivam Dwivedi, Niharika Singh, Arpit Agarwal, Abhishek Chauhan

Institution: Dr. Ram Manohar Lohia Institute of Medical Sciences

Language: English

Topic: Acute Lymphoblastic Leukemia research

Subfield: Public Health, Environmental and Occupational Health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

OpenAlex ID: W7133549461