SPONTANEOUS CORNEAL PERFORATION REVEALING ACUTE MYELOID LEUKAEMIA

Illustration of a Rare Case of Peripheral Ulcerative Keratitis (PUK) in the Context of Acute Myeloid Leukemia

Peripheral ulcerative keratitis (PUK) is a form of acute destructive keratitis
characterised by an epithelial defect and thinning of the corneal stroma(1,2). It is
often associated with autoimmune diseases, but can also be caused by bacterial or
viral infections, ocular trauma or drug reactions(2). Although rare, acute myeloid
leukaemia (AML) can be an important cause of PUK(2,3). 

We report here a case
of bilateral ulcerative keratitis spontaneously complicated by corneal perforation
in a patient with AML

This is a 31-year-old patient with acute myeloid leukemia (AML) who underwent a bone marrow transplant and is currently receiving chemotherapy. He presented with pain in the right eye (OD) associated with decreased vision, tearing, and photophobia for the past two months. The examination revealed a visual acuity in the right eye limited to counting fingers. A slit lamp examination showed diffuse conjunctival hyperemia and fibrosis of the palpebral conjunctiva. In the cornea, there was a lower ulcer, positive for fluorescein, with a clear interval from the limbus and stromal infiltration with neovascularization. The anterior chamber was calm in both eyes, as was the vitreous. The fundus examination was normal. The examination of the contralateral eye was normal. An additional Optical Coherence Tomography of the anterior segment (OCT-AS) was performed, showing stromal thinning with a very high risk of perforation.

It is crucial that ophthalmologists are aware of the ophthalmological
manifestations of acute myeloid leukaemia (AML). This can enable early
diagnosis and appropriate treatment of this potentially fatal disease. This case
highlights the importance of looking for systemic disease when marginal corneal
ulcers are present.