Purpose: To report on the clinical and cytopathological features of metastatic lung adenocarcinoma to the eye masquerading as an intermediate uveitis.
Methods: Retrospective chart review.
Results: A 63-year-old woman with a history of lung adenocarcinoma in remission presented with progressive vision loss and floaters in the right eye. Clinically, her uveitis was classified as a non-granulomatous anterior/intermediate uveitis. Pars plana vitrectomy was performed and cytopathology of the vitreous was unremarkable but directed polymerase chain reaction (PCR) was positive for HSV-1. Despite dual antiviral and antibiotic therapy, her visual acuity and intraocular inflammation progressively worsened prompting repeat vitrectomy with cytopathology revealing metastatic adenocarcinoma.
Conclusion: Intraocular metastatic lung adenocarcinoma can masquerade as an intermediate uveitis, presenting significant diagnostic challenges. Early and repeated cytopathological analysis of vitreous samples is crucial when the diagnosis remains uncertain, as it can lead to timely and accurate identification of metastatic carcinoma, thereby improving patient management and outcomes. This case underscores the diagnostic challenges and clinical complexity of distinguishing intraocular metastatic lung adenocarcinoma from intermediate uveitis.
Keywords: Intermediate uveitis; intraocular metastatic carcinoma; masquerade syndrome; ocular oncology; vitritis.