急性淋巴细胞白血病眼前节复发的临床特征 与诊断陷阱——以前葡萄膜炎伴前房积脓为首发表现的病例分析及文献复习

Clinical Characteristics and Diagnostic Pitfalls of Anterior Segment Relapse in Acute Lymphoblastic Leukemia—An Analysis of Cases Presenting with Anterior Uveitis and Hypopyon as the Initial Manifestation and a Literature Review

摘要: 目的：通过总结急性淋巴细胞白血病(ALL)缓解期眼前节复发的临床特征，明确疾病诊疗及鉴别要点，提高对于ALL眼前节复发的临床认知。方法：查阅相关文献及回顾2例ALL缓解期以急性前葡萄膜炎、前房积脓作为复发首发表现的临床病例。结果：2例ALL缓解期患者均以单眼视力下降起病，表现为前房极浅伴虹膜膨隆、前房积脓样改变及眼压显著升高。病例1初次骨髓与脑脊液检查阴性且局部激素治疗后短期缓解，随后出现眶部体征，复查脑脊液及MRI确诊复发；病例2通过前房冲洗渗出物细胞学检查明确复发。结论：ALL患者出现非典型葡萄膜炎、前房积脓伴继发性青光眼时应高度警惕眼前节浸润复发；早期骨髓/脑脊液阴性及局部治疗有效均不能排除复发。建议尽早行前房穿刺细胞学/虹膜取材并动态复查脑脊液与影像学检查，以减少误诊延误并尽快联合血液科系统治疗。

Abstract: Objective: To summarize the clinical characteristics of anterior segment relapse during remission in acute lymphoblastic leukemia (ALL), clarify the key points of diagnosis, treatment, and differential diagnosis, and enhance clinical awareness of anterior segment relapse in ALL. Methods: Relevant literature was reviewed, and two clinical cases of ALL in remission where acute anterior uveitis and hypopyon were the initial manifestations of relapse were retrospectively analyzed. Results: Both patients in remission presented with unilateral vision loss, characterized by an extremely shallow anterior chamber with iris bombe, hypopyon-like changes, and significantly elevated intraocular pressure. In Case 1, initial bone marrow and cerebrospinal fluid examinations were negative, and there was short-term remission following topical steroid therapy. Subsequently, orbital signs appeared, and a relapse was confirmed by repeat cerebrospinal fluid examination and MRI. In Case 2, relapse was confirmed by cytological examination of the exudate obtained via anterior chamber irrigation. Conclusion: Atypical uveitis, hypopyon accompanied by secondary glaucoma in patients with ALL should raise high suspicion for anterior segment relapse. Neither negative early bone marrow/cerebrospinal fluid findings nor a positive initial response to topical therapy can rule out relapse. Early performance of anterior chamber paracentesis for cytology/iris biopsy, along with dynamic re-examination of cerebrospinal fluid and imaging, is recommended to reduce misdiagnosis and delay, and to facilitate prompt consultation with the hematology department for systemic treatment.