Concurrent chronic follicular conjunctivitis and conjunctival MALT lymphoma potentially caused by Chlamydia...

Chlamydia, particularly C. psittaci, has been implicated in the pathogenesis of ocular adnexal lymphoma with varying geographical prevalence. We report a patient with concurrent chronic follicular conjunctivitis and conjunctiva mucosa-associated lymphoid tissue (MALT) lymphoma, potentially caused by C. pneumoniae. A 30-year-old female presented with a 10-month history of persistent discharge from the left eye. Examination of the conjunctiva revealed large follicles and a salmon-patched lesion over inferior fornix. Chlamydial antigen testing from conjunctival swab was positive, so the patient underwent a 3-week course of oral doxycycline (100 mg, twice daily), after which the discharge resolved, but the conjunctival mass persisted. A subsequent conjunctival biopsy identified extranodal marginal zone lymphoma of MALT type. Following systemic evaluations, clinical staging indicated T1N0M0, stage IE. The patient received a total 3060 cGy of radiotherapy in 17 fractions, leading to regression of the lesion. Touchdown Enzyme Time-Release polymerase chain reaction analysis of formalin-fixed paraffin-embedded biopsy samples confirmed the presence of C. pneumoniae DNA. This case highlights a potential association between chronic follicular conjunctivitis and conjunctival MALT lymphoma, possibly linked to C. pneumoniae infection. The potential causality warrants further investigation.