Peripheral ulcerative keratitis with bilateral optic nerve involvement as an initial presentation of acute lymphocytic leukemia in an adult.

To report a case of peripheral ulcerative keratitis (PUK) and scleritis, along with bilateral optic nerve infiltration as an initial presentation of acute lymphocytic leukemia (ALL) in an adult. Observational case report. A 24-year-old patient presented with complaints of pain, redness, and watering in the right eye since 15 days along with progressive decrease of vision since 3 months, leading to bilateral blindness. On examination, the visual acuity was absence of light perception in both eyes. Examination of the right eye revealed a PUK and adjacent localized scleritis. Fundus examination revealed bilateral multiple flame-shaped retinal haemorrhages. The optic discs in both eyes showed pallor with blurred margins. B-scan ultrasonography revealed bilateral optic nerve thickening. Head computed tomography was normal. Blood picture and bone marrow examination revealed features consistent with ALL. For sclerokeratitis, the patient was recommended topical steroids along with adjuvant therapy. She was referred to the oncology services for management of leukemia and was treated with chemotherapy. The sclerokeratitis responded well to medical management. However, no gain in vision could be achieved. ALL can present with sclerokeratitis and bilateral blindness due to optic nerve infiltration in an adult. Early diagnosis and prompt management may save the patient from blindness.