Systemic metastatic retinal lymphoma masquerading as granulomatous uveitis

To highlight the importance of considering systemic metastatic retinal lymphoma (SMRL) in the differential diagnosis of atypical uveitis and to emphasize the need for a comprehensive diagnostic and treatment approach for optimal patient outcomes.

Medical records and imaging of the patient were retrospectively reviewed.

A 61-year-old man presented with blurred vision, initially diagnosed as granulomatous uveitis following cataract surgery. Further ocular examination revealed optic nerve infiltration and retinal white infiltrates, prompting additional systemic evaluation. Imaging and biopsy confirmed a diagnosis of primary adrenal non-Hodgkin lymphoma with ocular involvement. The patient underwent R-CHOP chemotherapy and autologous stem cell transplantation during the COVID-19 pandemic, achieving systemic remission. However, due to pandemic-related logistical challenges, he declined further ocular treatment. At 1.5-year follow-up, his final visual acuity was 20/25 in the right eye and 20/125 in the left eye, with persistent cystoid macular edema in the left eye.

This case underscores the importance of recognizing SMRL as a potential cause of atypical uveitis, particularly in the presence of optic nerve and retinal infiltrates. It highlights the need for early diagnosis and a multidisciplinary approach, integrating systemic and ocular management to improve patient outcomes.