Blinded by Prostatic Adenocarcinoma - A Case of Cancer Associated Retinopathy with Multimodal Imaging

We report a rare case of cancer associated retinopathy with multimodal imaging, as an initial presentation of biopsy proven prostate acinar adenocarcinoma and a lung nodule with granulomatous inflammation.

Retrospective case report with review of literature.

A 71-year-old man with decrease in vision in left eye was diagnosed to have outer retinal involvement (OU) on autofluorescence and spectral OCT. PET CT scans showed enlargement of prostate with patchy areas of prostate specific membrane antigen avidity and a lung nodule. Biopsy of the prostate showed acinar adenocarcinoma while that of the lung nodule showed granulomatous inflammation, negative for AFB on culture and PCR. Inspite of intravenous methylprednisolone followed by oral steroids and therapeutic trial of antitubercular therapy, progression in the right eye threatening the fovea was noted in 9 days. Intravitreal ozurdex was given (OU) following which there was no progression. He also received mycophenolate mofetil 2 gm/day and hormonal therapy for the adenocarcinoma of the prostate. His serology was positive for carbonic anhydrase II autoantibodies (western blot) and showed strong staining of the IS-OS junction(on immunohistochemistry). At 1 year follow-up, the eye was stable with no improvement or further deterioration of vision or onset of fresh lesions.

Cancer associated retinopathy due to prostatic acinar adenocarcinoma is very rare. The autofluorescence and OCT show characteristic outer retinal involvement at the level of the RPE and photoreceptors. Intravitreal dexamethasone implant is a good option to prevent further vision loss.