Mittra R A, Pulido J S, Hanson G A, Kajdacsy-Balla A, Brummitt C F
The Vitreoretinal Service, Eye Institute, Medical College of Wisconsin, Milwaukee, USA.
Retina. 1999;19(1):45-50. doi: 10.1097/00006982-199901000-00007.
To report an unusual case of chronic multifocal chorioretinitis with vitritis in a patient with acquired immunodeficiency syndrome (AIDS) that was resistant to antiviral and antitoxoplasmic medication and required a retinal biopsy for definitive diagnosis.
Vitreous biopsy, pars plana vitrectomy, and retinal biopsy were performed. The vitreous biopsy material was sent for bacterial, fungal, and viral culture, and the vitreous cassette was sent for cytology. The retinal biopsy material was divided and sent for polymerase chain reaction testing for toxoplasmosis and virology and pathologic tissue analysis.
Vitreous cytology showed a mixed population of lymphocytes and histiocytes, but all other microbiologic and virologic studies were negative. Tissue analysis revealed an infiltrate of atypical mononuclear cells extending from the inner limiting membrane through the outer plexiform layer characteristic of a B cell, non-Hodgkin's lymphoma of the central nervous system (NHL-CNS). In situ hybridization for the Epstein-Barr virus (EBV) was positive. An extensive systemic evaluation did not show evidence of extraocular tumor.
Although rare, primary ocular NHL-CNS can be seen in patients with AIDS, and its clinical presentation often closely resembles other disorders. To our knowledge, this case represents the first ocular NHL in which EBV is shown to be associated.
报告1例获得性免疫缺陷综合征（AIDS）患者发生的对抗病毒和抗弓形虫药物耐药的慢性多灶性脉络膜视网膜炎伴玻璃体炎的罕见病例，该病例需要进行视网膜活检以明确诊断。
进行了玻璃体活检、睫状体平坦部玻璃体切除术和视网膜活检。将玻璃体活检材料送去进行细菌、真菌和病毒培养，将玻璃体标本送去进行细胞学检查。将视网膜活检材料分开送去进行弓形虫病的聚合酶链反应检测、病毒学检测和病理组织分析。
玻璃体细胞学检查显示淋巴细胞和组织细胞混合存在，但所有其他微生物学和病毒学研究均为阴性。组织分析显示，从内界膜延伸至外丛状层的非典型单核细胞浸润，这是中枢神经系统B细胞非霍奇金淋巴瘤（NHL-CNS）的特征。爱泼斯坦-巴尔病毒（EBV）原位杂交呈阳性。广泛的全身评估未显示眼外肿瘤的证据。
尽管原发性眼NHL-CNS在AIDS患者中罕见，但其临床表现常与其他疾病极为相似。据我们所知，该病例是首例显示与EBV相关的眼NHL。
