Malignant lymphoma involving the optic nerve head and the retina

A previously healthy 27-year-old man presented with a history of progressive paraplegia and blurred vision within one year. Physical examination revealed marked posterior column sign. Cerebrospinal fluid (CSF) contained a white blood count of 1,940 microL, all lymphocytes. Fundi revealed yellowish infiltration (candle-wax drippings) along retinal vessels and tumefaction of the optic nerve head. He was initially misdiagnosed as suffering from tuberculosis meningitis on the basis of the CSF findings. Sarcoidosis was then suspected because of the unusual fundus appearance. Malignant lymphoma was confirmed by inguinal lymph node biopsy.