{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T06:55:28Z","timestamp":1791960928045,"version":"4.3.4"},"reference-count":13,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,5,29]]},"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:p>We describe the case of a 22-year-old man who presented with right eye visual impairment and oral mucositis. MRI revealed findings compatible with right optic neuritis. Herpes simplex virus 1 was detected in oral swab. He has a previous history of acute myeloid leukaemia (AML) and was in clinical remission. Initial investigations for possible relapse of AML with central nervous system (CNS) involvement were negative. Treatment for HSV-related optic neuritis was initiated but the patient\u2019s vision deteriorated. Repeat MRI revealed right optic nerve infarct, new left optic nerve abnormality and new leptomeningeal enhancement in the brain. Repeated cerebrospinal fluid analysis confirmed CNS relapse of AML. Despite prompt initiation of pulse steroid and high dose intrathecal cytarabine followed by cranial irradiation, the patient never regained his vision. We present a case of unexpected optic neuropathy as first and sole presentation of CNS relapse of AML.<\/jats:p>","DOI":"10.1136\/bcr-2018-228125","type":"journal-article","created":{"date-parts":[[2019,6,21]],"date-time":"2019-06-21T06:16:12Z","timestamp":1561097772000},"page":"e228125","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Optic neuropathy as the first sign of central nervous system relapse in acute myeloid leukaemia: MRI findings and its diagnostic challenge"],"prefix":"10.1136","volume":"12","author":[{"given":"Michelle","family":"Cheung","sequence":"first","affiliation":[{"name":"Department of Radiology, Queen Mary Hospital, Pokfulam, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Queen Mary Hospital, Pokfulam, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymand","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Radiology, Queen Mary Hospital, Pokfulam, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,6,20]]},"reference":[{"key":"2025082803465475000_12.6.e228125.1","first-page":"1","article-title":"Acute myeloid leukemia relapse presenting as complete monocular vision loss due to optic nerve involvement","volume":"2016","author":"Patel","year":"2016","journal-title":"Case Rep Hematol"},{"key":"2025082803465475000_12.6.e228125.2","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1182\/blood.V65.5.1071.1071","article-title":"A unique pattern of central nervous system leukemia in acute myelomonocytic leukemia associated with inv(16)(p13q22)","volume":"65","author":"Holmes","year":"1985","journal-title":"Blood"},{"key":"2025082803465475000_12.6.e228125.3","first-page":"62","article-title":"[Ophthalmic manifestations of acute leukemia]","volume":"25","author":"Charif Chefchaouni","year":"2002","journal-title":"J Fr Ophtalmol"},{"key":"2025082803465475000_12.6.e228125.4","first-page":"npw006","article-title":"Optic neuropathy in the context of leukemia or lymphoma: diagnostic approach to a neuro-oncologic emergency","volume":"16","author":"Myers","year":"2016","journal-title":"Neurooncol Pract"},{"key":"2025082803465475000_12.6.e228125.5","doi-asserted-by":"publisher","DOI":"10.4103\/0971-3026.169462"},{"key":"2025082803465475000_12.6.e228125.6","first-page":"167","article-title":"Enhancement of optic nerve in leukemic patients: leukemic infiltration of optic nerve versus optic neuritis","volume":"20","author":"Yo","year":"2016","journal-title":"IMRI"},{"key":"2025082803465475000_12.6.e228125.7","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.2214\/AJR.16.16221","article-title":"MRI findings in patients with leukemia and positive CSF Cytology: A single-institution 5-year experience","volume":"207","author":"Guenette","year":"2016","journal-title":"AJR Am J Roentgenol"},{"key":"2025082803465475000_12.6.e228125.8","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2011.042960"},{"key":"2025082803465475000_12.6.e228125.9","doi-asserted-by":"crossref","first-page":"97","DOI":"10.2147\/CMAR.S125259","article-title":"Symptomatic central nervous system involvement in adult patients with acute myeloid leukemia","volume":"9","author":"Alakel","year":"2017","journal-title":"Cancer Manag Res"},{"key":"2025082803465475000_12.6.e228125.10","doi-asserted-by":"crossref","unstructured":"Bommer M , Nagy A , Sch\u00f6pflin C , et al . Cerebrospinal fluid pleocytosis: pitfalls and benefits of combined analysis using cytomorphology and flow cytometry. 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