Multiple choroidal granulomas in lymphomatoid granulomatosis: a case report

Lymphomatoid granulomatosis (LYG) is a rare B-cell lymphoproliferative disorder predominantly affecting middle-aged men. The disease occurs primarily in the lungs; however, reports of lesions in intraocular regions are scarce. Herein, we report a case of choroidal granulomas in a patient with LYG.

A 55-year-old male patient presented to a respiratory specialist with pneumonia of unknown cause. His serum-soluble IL-2 receptor level was highly elevated, and transbronchial lung biopsies revealed granulomatous lesions. Sarcoidosis was suspected, and an ophthalmological examination was performed. The best-corrected visual acuity was 1.2 in both eyes. Although no cells were present in the anterior chambers or anterior vitreous in either eye, multiple large yellowish-white exudates on the fundus of the right eye and soft exudates around the optic disc in the left eye were observed. Optical coherence tomography revealed choroidal granulomas consistent with the yellowish-white lesions in the right eye. Fluorescein angiography revealed tissue staining in the right eye consistent with granulomatous choroidal lesions. Both eyes showed capillaritis, mainly in the nasal retina. Subsequently, a thoracoscopic left lung biopsy led to a pathological diagnosis of LYG, and chemotherapy was initiated. Thereafter, the yellowish-white exudates gradually scarred, and the choroidal granulomas and soft exudates disappeared; thus, a vitreous biopsy was not performed. After autologous hematopoietic stem cell transplantation, the LYG was in remission. No ocular lesion recurrence was observed in the subsequent 18 months.

LYG may cause multiple large choroidal granulomas.