Background: Myelodysplastic syndrome is a clonal disease of the hematopoetic system characterized by insufficiency of affected bone marrow cell lines. After long-term course of myelodysplastic syndrome an acceleration towards acute myeloic leukemia is a frequent finding. Involvement of the eye is a well known phenomenon in acute leukemia or in blast crisis with chronic leukemias. Eye involvement in myelodysplastic syndrome showing its transition into acute myeloic leukemia however has been published in only few cases.
Case report: We present a 70-year-old male patient suffering from myelodysplastic syndrome, complaining of an acute visual decrease to 0.05 in the left eye. Clinical findings, ultrasound and fluoresceine angiography were in accordance with choroidal infiltration. From the hematologic findings, the myelodysplastic syndrome had been in partial remission after chemotherapy without any sign of relapse or exacerbation. Only because of the ophthalmologic diagnosis, bone marrow aspiration was performed and revealed progression of myelodysplastic syndrome to acute myeloic leukemia. Prompt administration of chemotherapy and external radiation of the posterior pol of the eye led to complete resolution of the fundus lesion within 10 days and visual acuity recovered to 0.8.
Conclusion: To the best of our knowledge this is the first patient with a choroidal infiltration as the initial sign of progression of myelodysplastic syndrome to acute myeloic leukemia. Realizing this possibility helps for an early diagnosis and rapid therapy which is so crucial in prolonging life.