PMC9285115_01
A) Fundus photo of the right eye showing dilated and tortuous retinal veins, optic disc edema and multiple flame-shaped, deep retinal hemorrhages involving posterior pole extending onto the retinal periphery suggestive of central retinal vein occlusion. B) Spectral domain optical coherence tomography (SD-OCT) of the same eye revealing subretinal fluid in the foveal region suggestive of cystoid macular edema. C) Bone marrow aspirate showing blasts, Leishman Giemsa stain, x1000 (yellow arrows). D) Blast cells showing myeloperoxidase (MPO) positivity (yellow arrows) with MPO stain, x1000 diagnostic of acute myelocytic leukemia.
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F1
Fundus examination revealed dilated and tortuous retinal veins, optic disc edema and multiple flame-shaped, deep retinal hemorrhages involving the posterior pole extending onto the retinal periphery suggestive of central retinal vein occlusion (Figure 1a (Fig. 1)). Fundus fluorescein angiography (FFA) showed a delay in arterio-venous transit time, and spectral domain optical coherence tomography (SD-OCT) revealed subretinal fluid in the foveal region suggestive of cystoid macular edema (Figure 1b (Fig. 1)). Erythroid series showed normoblastic maturation, myeloid series showed maturation up to neutrophilic series. 30% medium-sized blasts were seen (yellow arrows) with a high N:C ratio, 1-2 nucleoli and basophilic cytoplasm with no Auer rods (Figure 1c (Fig. 1)). The blasts showed myeloperoxidase (MPO) positivity (yellow arrows) with MPO stain, thus confirming the diagnosis of acute myeloid leukemia (AML) (Figure 1d (Fig. 1)).