Bilateral conjunctival MALT lymphoma mimicking chronic conjunctivitis

The diagnosis of conjunctival lymphoid tu-mors is straightforward when they present with a characteristic salmon-pink, pebbly, multinodular appearance. However, rarely a diffuse clinical presentation is encountered, and this may mimic chronic conjunctivitis of other etiologies.

A 60-year-old man was referred to our clinic with bilateral conjunctival masses in May 2005. With the assumption of chlamydial conjunctivitis, without microbiological or histopathological evidence, tetracycline ointment and oral doxycycline 100 mg twice daily were prescribed. Although a partial response was achieved, 2 months after the treatment, the patient's complaints returned. On second referral to our clinic in March 2006, the patient was re-evaluated. He presented with bilateral conjunctival masses resembling conjunctival lymphoma, and a bilateral diagnostic biopsy was performed. Histopathological evaluation of the biopsy specimens revealed mucosa-associated lymphoid tissue (MALT) lymphoma. The patient received CVP chemotherapy (cyclophosphamide, vincristine, prednisolone). After 6 courses of chemotherapy, he achieved partial remission in both eyes. Currently, 28 months after CVP, sustained remission is obtained.

In these cases, a high index of suspicion is required if one is to avoid a delay in diagnosis, and the importance of correct early diagnosis is obvious.