Vitreoretinal lymphoma, secondary to non-CNS systemic lymphoma, masquerading as an infectious retinitis

Varun Reddy, Richard Winslow, Jennifer H. Cao, Zachary M. Robertson, Bo Chen, Rafael Ufret-Vincenty

Research output: Contribution to journalArticle

Abstract

Purpose: To report an atypical case of vitreoretinal lymphoma, secondary to non-central nervous system (non-CNS) systemic lymphoma, masquerading as an infectious retinitis. Observations: A 76-year-old female with a history of cecal diffuse large B-cell lymphoma with two prior occurrences of posterior segment ocular involvement presented with a complaint of blurry vision in the right eye. Exam findings were significant for large areas of retinal whitening and retinal hemorrhages in the absence of choroidal lesions or significant vitritis. The clinical suspicion of an infectious retinitis, was supported by a presumptive immunosuppressive state secondary to her recent treatment (within 1 month) with both intravitreal and systemic rituximab plus high-dose methotrexate. Aggressive treatment with intravitreal and systemic antivirals and antibiotics was initiated. However, polymerase chain reaction (PCR) testing of aqueous fluid was negative for cytomegalovirus (CMV), herpes simplex virus, herpes zoster virus and toxoplasma, and her condition continued to worsen, so suspicion was raised for a masquerading recurrent malignancy. She was treated empirically with serial intravitreal injections of methotrexate and showed dramatic clinical improvement. A subsequent relapse occurred that responded rapidly to intravitreal methotrexate in the absence of antiviral/antibiotics. Conclusion: It is important for clinicians to be aware of atypical presentations of vitreoretinal lymphoma. This case emphasizes the fact that secondary ocular lymphoma after systemic lymphoma can have a vitreoretinal presentation rather than the more common choroidal involvement. Furthermore, it shows that recurrences of this disease in the same patient can have very different manifestations, including an appearance indistinguishable from a viral retinitis.

Original languageEnglish (US)
Article number100545
JournalAmerican Journal of Ophthalmology Case Reports
Volume16
DOIs
StatePublished - Dec 1 2019

Fingerprint

Retinitis
Nervous System
Lymphoma
Methotrexate
Antiviral Agents
Anti-Bacterial Agents
Retinal Hemorrhage
Recurrence
Intravitreal Injections
Human Herpesvirus 3
Lymphoma, Large B-Cell, Diffuse
Toxoplasma
Simplexvirus
Immunosuppressive Agents
Cytomegalovirus
Polymerase Chain Reaction
Therapeutics
Neoplasms

Keywords

  • Cytomegalovirus
  • Lymphoma
  • Masquerade
  • Retinitis
  • Vitreoretinal lymphoma

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Vitreoretinal lymphoma, secondary to non-CNS systemic lymphoma, masquerading as an infectious retinitis. / Reddy, Varun; Winslow, Richard; Cao, Jennifer H.; Robertson, Zachary M.; Chen, Bo; Ufret-Vincenty, Rafael.

In: American Journal of Ophthalmology Case Reports, Vol. 16, 100545, 01.12.2019.

Research output: Contribution to journalArticle

@article{f3ca1af87805412393cb6d4b8d31e732,
title = "Vitreoretinal lymphoma, secondary to non-CNS systemic lymphoma, masquerading as an infectious retinitis",
abstract = "Purpose: To report an atypical case of vitreoretinal lymphoma, secondary to non-central nervous system (non-CNS) systemic lymphoma, masquerading as an infectious retinitis. Observations: A 76-year-old female with a history of cecal diffuse large B-cell lymphoma with two prior occurrences of posterior segment ocular involvement presented with a complaint of blurry vision in the right eye. Exam findings were significant for large areas of retinal whitening and retinal hemorrhages in the absence of choroidal lesions or significant vitritis. The clinical suspicion of an infectious retinitis, was supported by a presumptive immunosuppressive state secondary to her recent treatment (within 1 month) with both intravitreal and systemic rituximab plus high-dose methotrexate. Aggressive treatment with intravitreal and systemic antivirals and antibiotics was initiated. However, polymerase chain reaction (PCR) testing of aqueous fluid was negative for cytomegalovirus (CMV), herpes simplex virus, herpes zoster virus and toxoplasma, and her condition continued to worsen, so suspicion was raised for a masquerading recurrent malignancy. She was treated empirically with serial intravitreal injections of methotrexate and showed dramatic clinical improvement. A subsequent relapse occurred that responded rapidly to intravitreal methotrexate in the absence of antiviral/antibiotics. Conclusion: It is important for clinicians to be aware of atypical presentations of vitreoretinal lymphoma. This case emphasizes the fact that secondary ocular lymphoma after systemic lymphoma can have a vitreoretinal presentation rather than the more common choroidal involvement. Furthermore, it shows that recurrences of this disease in the same patient can have very different manifestations, including an appearance indistinguishable from a viral retinitis.",
keywords = "Cytomegalovirus, Lymphoma, Masquerade, Retinitis, Vitreoretinal lymphoma",
author = "Varun Reddy and Richard Winslow and Cao, {Jennifer H.} and Robertson, {Zachary M.} and Bo Chen and Rafael Ufret-Vincenty",
year = "2019",
month = "12",
day = "1",
doi = "10.1016/j.ajoc.2019.100545",
language = "English (US)",
volume = "16",
journal = "American Journal of Ophthalmology Case Reports",
issn = "2451-9936",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Vitreoretinal lymphoma, secondary to non-CNS systemic lymphoma, masquerading as an infectious retinitis

AU - Reddy, Varun

AU - Winslow, Richard

AU - Cao, Jennifer H.

AU - Robertson, Zachary M.

AU - Chen, Bo

AU - Ufret-Vincenty, Rafael

PY - 2019/12/1

Y1 - 2019/12/1

N2 - Purpose: To report an atypical case of vitreoretinal lymphoma, secondary to non-central nervous system (non-CNS) systemic lymphoma, masquerading as an infectious retinitis. Observations: A 76-year-old female with a history of cecal diffuse large B-cell lymphoma with two prior occurrences of posterior segment ocular involvement presented with a complaint of blurry vision in the right eye. Exam findings were significant for large areas of retinal whitening and retinal hemorrhages in the absence of choroidal lesions or significant vitritis. The clinical suspicion of an infectious retinitis, was supported by a presumptive immunosuppressive state secondary to her recent treatment (within 1 month) with both intravitreal and systemic rituximab plus high-dose methotrexate. Aggressive treatment with intravitreal and systemic antivirals and antibiotics was initiated. However, polymerase chain reaction (PCR) testing of aqueous fluid was negative for cytomegalovirus (CMV), herpes simplex virus, herpes zoster virus and toxoplasma, and her condition continued to worsen, so suspicion was raised for a masquerading recurrent malignancy. She was treated empirically with serial intravitreal injections of methotrexate and showed dramatic clinical improvement. A subsequent relapse occurred that responded rapidly to intravitreal methotrexate in the absence of antiviral/antibiotics. Conclusion: It is important for clinicians to be aware of atypical presentations of vitreoretinal lymphoma. This case emphasizes the fact that secondary ocular lymphoma after systemic lymphoma can have a vitreoretinal presentation rather than the more common choroidal involvement. Furthermore, it shows that recurrences of this disease in the same patient can have very different manifestations, including an appearance indistinguishable from a viral retinitis.

AB - Purpose: To report an atypical case of vitreoretinal lymphoma, secondary to non-central nervous system (non-CNS) systemic lymphoma, masquerading as an infectious retinitis. Observations: A 76-year-old female with a history of cecal diffuse large B-cell lymphoma with two prior occurrences of posterior segment ocular involvement presented with a complaint of blurry vision in the right eye. Exam findings were significant for large areas of retinal whitening and retinal hemorrhages in the absence of choroidal lesions or significant vitritis. The clinical suspicion of an infectious retinitis, was supported by a presumptive immunosuppressive state secondary to her recent treatment (within 1 month) with both intravitreal and systemic rituximab plus high-dose methotrexate. Aggressive treatment with intravitreal and systemic antivirals and antibiotics was initiated. However, polymerase chain reaction (PCR) testing of aqueous fluid was negative for cytomegalovirus (CMV), herpes simplex virus, herpes zoster virus and toxoplasma, and her condition continued to worsen, so suspicion was raised for a masquerading recurrent malignancy. She was treated empirically with serial intravitreal injections of methotrexate and showed dramatic clinical improvement. A subsequent relapse occurred that responded rapidly to intravitreal methotrexate in the absence of antiviral/antibiotics. Conclusion: It is important for clinicians to be aware of atypical presentations of vitreoretinal lymphoma. This case emphasizes the fact that secondary ocular lymphoma after systemic lymphoma can have a vitreoretinal presentation rather than the more common choroidal involvement. Furthermore, it shows that recurrences of this disease in the same patient can have very different manifestations, including an appearance indistinguishable from a viral retinitis.

KW - Cytomegalovirus

KW - Lymphoma

KW - Masquerade

KW - Retinitis

KW - Vitreoretinal lymphoma

UR - http://www.scopus.com/inward/record.url?scp=85070934924&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070934924&partnerID=8YFLogxK

U2 - 10.1016/j.ajoc.2019.100545

DO - 10.1016/j.ajoc.2019.100545

M3 - Article

VL - 16

JO - American Journal of Ophthalmology Case Reports

JF - American Journal of Ophthalmology Case Reports

SN - 2451-9936

M1 - 100545

ER -