Infiltrative lymphomatous optic neuropathy in non-Hodgkin lymphoma

We report a 67-year-old man with non-Hodgkin lymphoma who presented with fluctuating visual loss which responded partially to steroid treatment. Multiple lumbar punctures did not show lymphoblastic cells and multiple MRI did not show any central nervous system disease except for isolated optic nerve enhancement. A fundus examination revealed combined arterial and venous occlusion and optic disc swelling. Due to conflicts between the examinations and investigations, there was a reluctance to initiate radiotherapy until progressive changes involving both eyes occurred. The man died 8 months after he was diagnosed with lymphoma. A post mortem optic nerve biopsy showed lymphomatous infiltration, confirming that the initial suspicion based on the clinical findings was correct.