Primary intraocular central nervous system lymphoma masquerading as diffuse retinal vasculitis

BMJ Case Rep. 2013 Apr 30:2013:bcr2013009354. doi: 10.1136/bcr-2013-009354.

Abstract

A 49-year-old woman had blurred vision and floaters of 4 days duration in the right eye. Ocular examination revealed granulomatous panuveitis, vitritis and diffuse retinal vasculitis. Following a strongly positive tuberculin skin test, she received antitubercular therapy with oral steroids and immunosuppressants. A year later, despite therapy, vitritis and vasculitis persisted. Additionally, yellowish white lesions appeared beneath the retinal pigment epithelium. Fluorescein angiography revealed a leopard skin appearance. Following a negative vitreous biopsy, she was subjected to a chorioretinal biopsy which revealed non-Hodgkin's lymphoma. MRI was normal. The ocular lesions resolved following intravitreal methotrexate injections. MRI of the brain was repeated every 3 months to rule out central nervous system (CNS) involvement. About 2.5 years after initial presentation, she complained of ataxia, hypersomnia and speech difficulty. MRI of the brain now showed lesions in the thalamocapsular region and the corpus callosum splenium suggestive of CNS lymphoma. She underwent a whole brain radiation with symptomatic improvement followed by chemotherapy.

Publication types

  • Case Reports

MeSH terms

  • Angiography
  • Central Nervous System Neoplasms / diagnosis*
  • Central Nervous System Neoplasms / drug therapy
  • Central Nervous System Neoplasms / radiotherapy
  • Combined Modality Therapy
  • Diagnosis, Differential
  • Eye Neoplasms / diagnosis*
  • Eye Neoplasms / drug therapy
  • Eye Neoplasms / radiotherapy
  • Female
  • Humans
  • Lymphoma, Non-Hodgkin / diagnosis*
  • Lymphoma, Non-Hodgkin / drug therapy
  • Lymphoma, Non-Hodgkin / radiotherapy
  • Magnetic Resonance Imaging
  • Middle Aged
  • Retinal Vasculitis / diagnosis*
  • Retinal Vasculitis / drug therapy
  • Retinal Vasculitis / surgery