[A case of intraocular lymphoma with papillitis optica and retinal vasculitis]

We report a case of intraocular lymphoma with presenting symptoms of hyperemia and swelling of the optic disc, and retinal vasculitis, which was difficult to diagnose.

A 53-year-old woman visited a local doctor because of decreased vision OS. Fundus examination of the left eye revealed hyperemia and swelling of the optic disc as well as retinal vasculitis. She was treated with systemic corticosteroids. However, since there was no improvement in the ocular findings, she was referred to the Department of Ophthalmology of Tokyo Medical University Hospital. At presentation, mild anterior segment inflammation was observed, together with sheathing mainly of the veins as well as hyperemia and swelling of the optic disc in the fundus. Because the patient did not respond to corticosteroid treatment and the subretinal exudative lesion around the optic disc subsequently worsened, intraocular lymphoma was suspected. Diagnostic vitrectomy was performed. The vitreous cytology was class III. Although polymerase chain reaction detected no immunoglobulin gene rearrangement, interleukin (IL)-10 was 4290 pg/ml and IL-6 was 94 pg/ml in the vitreous fluid. Based on these data and the clinical course, the diagnosis of intraocular lymphoma was made. Shortly after radiotherapy to the eyeball, the optic disk findings improved and the retinal vasculitis was resolved; visual acuity improved as well.

Intraocular lymphoma may present with atypical findings of optic disk inflammation and retinal vasculitis.