Vitreoretinal lymphoma, secondary to non-CNS systemic lymphoma, masquerading as an infectious retinitis
Purpose: To report an atypical case of vitreoretinal lymphoma, secondary to non-central nervous system (non-CNS) systemic lymphoma, masquerading as an infectious retinitis. Observations: A 76-year-old female with a history of cecal diffuse large B-cell lymphoma with two prior occurrences of posterio...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2019-12-01
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| Series: | American Journal of Ophthalmology Case Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2451993618302767 |
| _version_ | 1811306570663854080 |
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| author | Varun Reddy Richard Winslow Jennifer H. Cao Zachary M. Robertson Bo Chen Rafael L. Ufret-Vincenty |
| author_facet | Varun Reddy Richard Winslow Jennifer H. Cao Zachary M. Robertson Bo Chen Rafael L. Ufret-Vincenty |
| author_sort | Varun Reddy |
| collection | DOAJ |
| description | Purpose: To report an atypical case of vitreoretinal lymphoma, secondary to non-central nervous system (non-CNS) systemic lymphoma, masquerading as an infectious retinitis. Observations: A 76-year-old female with a history of cecal diffuse large B-cell lymphoma with two prior occurrences of posterior segment ocular involvement presented with a complaint of blurry vision in the right eye. Exam findings were significant for large areas of retinal whitening and retinal hemorrhages in the absence of choroidal lesions or significant vitritis. The clinical suspicion of an infectious retinitis, was supported by a presumptive immunosuppressive state secondary to her recent treatment (within 1 month) with both intravitreal and systemic rituximab plus high-dose methotrexate. Aggressive treatment with intravitreal and systemic antivirals and antibiotics was initiated. However, polymerase chain reaction (PCR) testing of aqueous fluid was negative for cytomegalovirus (CMV), herpes simplex virus, herpes zoster virus and toxoplasma, and her condition continued to worsen, so suspicion was raised for a masquerading recurrent malignancy. She was treated empirically with serial intravitreal injections of methotrexate and showed dramatic clinical improvement. A subsequent relapse occurred that responded rapidly to intravitreal methotrexate in the absence of antiviral/antibiotics. Conclusion: It is important for clinicians to be aware of atypical presentations of vitreoretinal lymphoma. This case emphasizes the fact that secondary ocular lymphoma after systemic lymphoma can have a vitreoretinal presentation rather than the more common choroidal involvement. Furthermore, it shows that recurrences of this disease in the same patient can have very different manifestations, including an appearance indistinguishable from a viral retinitis. Keywords: Lymphoma, Vitreoretinal lymphoma, Masquerade, Cytomegalovirus, Retinitis |
| first_indexed | 2024-04-13T08:47:44Z |
| format | Article |
| id | doaj.art-6532b5289f8a4ba090f50571e13a55ce |
| institution | Directory Open Access Journal |
| issn | 2451-9936 |
| language | English |
| last_indexed | 2024-04-13T08:47:44Z |
| publishDate | 2019-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Ophthalmology Case Reports |
| spelling | doaj.art-6532b5289f8a4ba090f50571e13a55ce2022-12-22T02:53:37ZengElsevierAmerican Journal of Ophthalmology Case Reports2451-99362019-12-0116Vitreoretinal lymphoma, secondary to non-CNS systemic lymphoma, masquerading as an infectious retinitisVarun Reddy0Richard Winslow1Jennifer H. Cao2Zachary M. Robertson3Bo Chen4Rafael L. Ufret-Vincenty5Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, 75390-9057, USADepartment of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, 75390-9057, USADepartment of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, 75390-9057, USADepartment of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, 75390-9057, USADepartment of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, 75390-9057, USA; Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, ChinaDepartment of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, 75390-9057, USA; Corresponding author. Department of Ophthalmology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9057, USA.Purpose: To report an atypical case of vitreoretinal lymphoma, secondary to non-central nervous system (non-CNS) systemic lymphoma, masquerading as an infectious retinitis. Observations: A 76-year-old female with a history of cecal diffuse large B-cell lymphoma with two prior occurrences of posterior segment ocular involvement presented with a complaint of blurry vision in the right eye. Exam findings were significant for large areas of retinal whitening and retinal hemorrhages in the absence of choroidal lesions or significant vitritis. The clinical suspicion of an infectious retinitis, was supported by a presumptive immunosuppressive state secondary to her recent treatment (within 1 month) with both intravitreal and systemic rituximab plus high-dose methotrexate. Aggressive treatment with intravitreal and systemic antivirals and antibiotics was initiated. However, polymerase chain reaction (PCR) testing of aqueous fluid was negative for cytomegalovirus (CMV), herpes simplex virus, herpes zoster virus and toxoplasma, and her condition continued to worsen, so suspicion was raised for a masquerading recurrent malignancy. She was treated empirically with serial intravitreal injections of methotrexate and showed dramatic clinical improvement. A subsequent relapse occurred that responded rapidly to intravitreal methotrexate in the absence of antiviral/antibiotics. Conclusion: It is important for clinicians to be aware of atypical presentations of vitreoretinal lymphoma. This case emphasizes the fact that secondary ocular lymphoma after systemic lymphoma can have a vitreoretinal presentation rather than the more common choroidal involvement. Furthermore, it shows that recurrences of this disease in the same patient can have very different manifestations, including an appearance indistinguishable from a viral retinitis. Keywords: Lymphoma, Vitreoretinal lymphoma, Masquerade, Cytomegalovirus, Retinitishttp://www.sciencedirect.com/science/article/pii/S2451993618302767 |
| spellingShingle | Varun Reddy Richard Winslow Jennifer H. Cao Zachary M. Robertson Bo Chen Rafael L. Ufret-Vincenty Vitreoretinal lymphoma, secondary to non-CNS systemic lymphoma, masquerading as an infectious retinitis American Journal of Ophthalmology Case Reports |
| title | Vitreoretinal lymphoma, secondary to non-CNS systemic lymphoma, masquerading as an infectious retinitis |
| title_full | Vitreoretinal lymphoma, secondary to non-CNS systemic lymphoma, masquerading as an infectious retinitis |
| title_fullStr | Vitreoretinal lymphoma, secondary to non-CNS systemic lymphoma, masquerading as an infectious retinitis |
| title_full_unstemmed | Vitreoretinal lymphoma, secondary to non-CNS systemic lymphoma, masquerading as an infectious retinitis |
| title_short | Vitreoretinal lymphoma, secondary to non-CNS systemic lymphoma, masquerading as an infectious retinitis |
| title_sort | vitreoretinal lymphoma secondary to non cns systemic lymphoma masquerading as an infectious retinitis |
| url | http://www.sciencedirect.com/science/article/pii/S2451993618302767 |
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