Fundus white spots associated with graft-versus-host disease in the remission phase of acute myeloid leukemia

Purpose: To report a case of fundus white spots associated with graft-versus-host disease (GVHD) during the remission phase of acute myelogenous leukemia (AML). Observations: A 60-year-old woman was diagnosed with AML 7 months earlier, and after 3 months of chemotherapy, she underwent bone marrow transplantation 2 months earlier and was in remission. When she first came to our department with the chief complaint of persistent bilateral floaters before she developed AML, she had a skin rash caused by GVHD that had been diagnosed 4 days earlier, and the fundi of both eyes showed multiple white spots in the deep retinal layers. One month later, the GVHD skin rash had resolved with topical steroid treatment, and the fundus white spots had mostly disappeared. Fifteen months after the initial visit, the fundus white spots had completely disappeared, with remaining hypofluorescent dots on fundus autofluorescence. Her best-corrected visual acuity was 1.2 in each eye at the first visit and remained at 1.0 in the right eye and 1.2 in the left eye at the final visit 15 months later. Conclusions and importance: Fundus white spots may occur in the early phase of GVHD, causing focal retinal pigment epithelium atrophy after resolution.