A case of intravascular lymphoma diagnosed with a primary vitreoretinal lymphoma-like fundus lesion

Journal of Ophthalmic Inflammation and Infection - 2021
Masaki Asakage1, Kazuhiko Umazume1, Hiroyuki Takoi2, Daigo Akahane3, Yasunori Ishibashi4, Hiroshi Yamaguchi4, Masahide Gondo5, Hiroshi Gotô1
1Department of Ophthalmology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-00023, Japan
2Department of Respiratory Medicine, Tokyo Medical University, Tokyo, Japan
3Department of Hematology, Tokyo Medical University, Tokyo, Japan
4Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
5Department of Dermatology, Tokyo Medical University, Tokyo, Japan

Tóm tắt

Abstract Purpose We report a case of intravascular lymphoma with primary vitreoretinal lymphoma-like fundus findings. Case A 61-year-old man with a one-week history of temporal visual field defect in the left eye was referred by a local ophthalmologist to our department. A yellowish-white raised patchy lesion was found in the nasal fundus of the left eye. Vitreoretinal lymphoma was suspected, and vitrectomy was performed in the left eye for diagnostic purpose. However, vitreous interleukin-10 concentration was low and no significant result was obtained. He had fever of around 38 °C, and respiratory failure that started 2 weeks before ophthalmological examination, worsened. Intravascular lymphoma was diagnosed from the results of histopathological examinations of transbronchial lung biopsy, bone marrow biopsy and random skin biopsy. With the start of systemic chemotherapy, the subretinal lesions shrank gradually and systemic condition was stable. However, 5 months after the start of chemotherapy, spread to the central nervous system was observed, and chimeric antigen receptor T cell (CAR-T) therapy was started in another hospital. After the start of CAR-T therapy, the subretinal lesions shrank further. Conclusions Intravascular lymphoma may be accompanied by primary vitreoretinal lymphoma-like intraocular lesions. If intraocular lesions are accompanied by systemic symptoms such as fever of unknown origin, the possibility of intravascular lymphoma should be suspected and systemic work-up should be performed.

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Journal of Ophthalmic Inflammation and Infection

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