J Clin Ophthalmol Eye Disord | Volume 5, Issue 1 | Short Communication | Open Access
Elewys H1 and Susan L2*
1Department of Clinical Ophthalmology, ST4 Severn Deanery, UK
2Department of Clinical Ophthalmology, University of the Highlands and Islands, UK
*Correspondance to: Susan Lightman
Fulltext PDFBackground: This case is a young woman presenting with apparent bilateral intermediate uveitis where the final diagnosis is of bilateral Primary Intraocular Lymphoma (PIOL). The diagnostic challenges are reviewed, and the clinical features are described. Case Report: A 32-year-old lady presented with a 3-month history of bilateral floaters, with no past medical history, no medications, and a normal systems review. Examination revealed her Visual Acuity (VA) was 6/6 in both eyes, 1+ of anterior chamber cells and 3+ of vitreous cells in both eyes. OCT illustrated normal maculae and optic discs, and an initial diagnosis of bilateral intermediate uveitis was made. The treatment of high dose oral steroids made no change clinically and VA remained at 6/6 in both eyes. A vitreous biopsy gave the correct diagnosis of a bilateral diffuse large B-cell lymphoma. MRI head and orbits illustrated no concurrent primary Central Nervous System (CNS) involvement. Ocular irradiation with prophylactic CNS treatment was given in combination with systemic chemotherapy. Initially there was a good response to treatment, but both eyes then relapsed so intravitreal methotrexate was administered. Conclusion: We report a rare case of bilateral PIOL with no concurrent Primary Central System Lymphoma (PCNSL), initially diagnosed as bilateral intermediate uveitis presenting to the uveitis clinic at Moorfield’s Eye Hospital. PIOL is a great imitator so a high degree of clinical suspicion is essential in uveitis refractive to treatment to avoid prolonging the delay in diagnosis.
Elewys H, Susan L. Beware the Masquerade!. J Clin Ophthalmol Eye Disord. 2021; 5(1): 1036.