Bilateral pseudohypopyon as a presenting feature of recurrent diffuse large B-cell lymphoma

Area of Science:

• Ophthalmology
• Hematology
• Oncology

Background:

• Gaucher disease and B-cell lymphoma can present with complex ocular manifestations.
• Distinguishing between true hypopyon and pseudohypopyon is critical for diagnosis and treatment.
• Diffuse large B-cell lymphoma (DLBCL) is an aggressive non-Hodgkin lymphoma.

Observation:

• A 55-year-old male with Gaucher disease and DLBCL presented with a bilateral white meniscus in the anterior chamber of both eyes.
• The meniscus shape in one eye shifted with patient positioning, suggesting a fluid or cell suspension.
• Aspiration of the anterior chamber revealed lymphoma cells, confirming a pseudohypopyon.

Findings:

• The binocular pseudohypopyon was definitively diagnosed as lymphomatous using flow cytometric immunophenotyping.
• This represents the first documented case of bilateral pseudohypopyon caused by lymphoma in a DLBCL patient.
• The presence of pseudohypopyon was associated with a poor prognosis, with patient expiration within 14 weeks.

Implications:

• Pseudohypopyon can be an indicator of intraocular lymphoma, even in the absence of typical ocular symptoms.
• Early and accurate diagnosis of ocular lymphoma is crucial for appropriate management and patient outcomes.
• This case highlights the importance of considering lymphoma in the differential diagnosis of anterior chamber pseudohypopyon, especially in immunocompromised patients.