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Lymphoma masquerading as occlusive retinal vasculitis: A case study.

Scott J Sonne¹, Wen-Shi Shieh², Sunil K Srivastava³

¹Saint Louis University School of Medicine, St. Louis, MO, USA.

American Journal of Ophthalmology Case Reports

|July 3, 2020

Summary

Retinal lymphoma can mimic occlusive retinal vasculitis without vitritis, responding temporarily to intravitreal dexamethasone implant (IVDI). Early diagnosis and multimodal therapy are crucial for managing this rare presentation.

Keywords:

Intravitreal dexamethasone Lymphoma Occlusive vasculitis Ozurdex Retinal vasculitis Uveitis

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Area of Science:

Ophthalmology
Oncology
Retinal Diseases

Background:

Retinal lymphoma is a rare intraocular malignancy.
It can present with diverse clinical features, sometimes mimicking inflammatory conditions.
Early and accurate diagnosis is critical for effective management.

Observation:

A 66-year-old male presented with vision loss and retinal vasculitis without vitritis.
Initial treatments with systemic steroids and cyclophosphamide were ineffective.
Intravitreal dexamethasone implant (IVDI) led to significant visual and clinical improvement, masking the underlying lymphoma.

Findings:

The patient later developed lymphomatous infiltration in the subretinal space and corpus callosum.
The initial presentation of retinal vasculitis was responsive to IVDI, highlighting a potential diagnostic challenge.
Multimodal therapy including intravitreal methotrexate, rituximab, and autologous stem cell transplant led to sustained disease remission.

Implications:

Retinal lymphoma should be considered in cases of unexplained retinal vasculitis, even without vitritis.
The temporary response to IVDI can mask lymphoma, necessitating thorough systemic evaluation.
Aggressive and tailored treatment strategies are essential for managing ocular lymphoma.