SYSTEMIC LYMPHOMA MASQUERADING AS BIRDSHOT CHORIORETINOPATHY.

Area of Science:

• Ophthalmology
• Oncology
• Medical Genetics

Background:

• Birdshot-like chorioretinopathy (BSCR) is typically associated with the HLA-A29 allele.
• Systemic lymphoma can present with diverse ocular manifestations.
• Atypical presentations of BSCR warrant thorough investigation for underlying neoplastic or autoimmune conditions.

Purpose of the Study:

• To describe a rare instance of BSCR in a patient negative for HLA-A29.
• To investigate the potential link between systemic lymphoma and BSCR.
• To highlight the importance of considering masquerade syndromes in BSCR diagnosis.

Main Methods:

• Case report of a 58-year-old male with blurry vision and floaters.
• Clinical examination revealed bilateral atrophic birdshot-like choroidal lesions.
• Diagnostic work-up included HLA typing, infectious disease screening, MRI, and electroretinography (ffERG, mfERG).

Main Results:

• The patient was HLA-A29 negative, with no evidence of syphilis or tuberculosis.
• MRI showed cranial nerve enhancement, but no overt malignancy.
• Ocular findings remained stable over two years, despite a later diagnosis of diffuse large B-cell lymphoma (DLBCL).

Conclusions:

• BSCR masquerade syndromes should be considered in HLA-A29 negative patients with birdshot-like lesions, especially those with a history of lymphoma.
• The patient's chronic choroidal findings may be linked to prior low-grade B-cell lymphoma and chemotherapy.
• The relationship between choroidal involvement and transformation to high-grade lymphoma remains unclear.