SYSTEMIC LYMPHOMA MASQUERADING AS BIRDSHOT CHORIORETINOPATHY

To report a rare case of systemic lymphoma causing a birdshot-like chorioretinopathy in a histocompatibility leukocyte antigen-A29-negative patient.

A 58-year-old man presented with a 1-year history of blurry vision and intermittent floaters. He had evidence of bilateral choroidal birdshot-like lesions that appeared atrophic without any vitritis. He had a history of low-grade B-cell lymphoma and chronic myeloid leukemia, both of which were diagnosed >10 years before presentation and treated with chemotherapy.

The differential diagnosis of these birdshot-like lesions included autoimmune, neoplastic, and infectious etiologies. Work-up revealed a negative histocompatibility leukocyte antigen-A29 and negative results for syphilis and tuberculosis. Magnetic resonance imaging revealed enhancement of the trigeminal and oculomotor nerve cisternal segments but no overt evidence of malignancy. Full-field electroretinogram and multifocal electroretinogram tests were within normal limits. Serial follow-up clinical examinations, retinal imaging, full-field electroretinogram, and multifocal electroretinogram demonstrated no disease progression. Two years after his initial consultation, he developed a paraspinal mass that was biopsied and found to be diffuse large B-cell lymphoma and was treated with chemotherapy.

Clinicians should consider birdshot-like chorioretinopathy masquerade syndromes in patients who present with birdshot-like choroidal lesions with negative histocompatibility leukocyte antigen-A29, a history of lymphoma, or atypical characteristics. In this case, the authors suspect the patient's past low-grade B-cell lymphoma, and chemotherapy resulted in the chronic choroidal findings. It is unclear whether choroidal involvement predisposes a patient to high-grade transformation to diffuse large B-cell lymphoma. His ocular findings remained inactive throughout the treatment of his diffuse large B-cell lymphoma.