Department of Pathology and Genomic Medicine, Ocular Pathology, Houston Methodist Hospital, Houston, TX.
Department of Ophthalmology, Houston Methodist Hospital, Houston, TX.
Surv Ophthalmol. 2014 Jul-Aug;59(4):468-73. doi: 10.1016/j.survophthal.2013.10.003. Epub 2013 Oct 17.
A 55-year-old HIV-positive man presented with acute vision loss in the right eye and altered mental status. Ophthalmic evaluation revealed light perception vision OD with a right relative afferent pupillary defect, conjunctival chemosis, large mutton-fat keratitic precipitates, and diffuse cream-colored vitreous cells. Magnetic resonance imaging of the brain and orbit with and without contrast with fat saturation showed choroidal thickening OD, multifocal deep periventricular and deep ganglionic enhancing lesions, and a suprasellar mass. Brain biopsy showed diffuse large B-cell lymphoma. Intrathecal chemotherapy with methotrexate and cytarabine and whole brain radiation therapy failed. His mental status deteriorated. He developed pancytopenia, neutropenic fever, and septic shock and subsequently expired under palliative care.
一位 55 岁的 HIV 阳性男性因右眼视力急剧下降和精神状态改变而就诊。眼科检查发现右眼光感,右眼相对传入瞳孔缺损,结膜水肿,大的羊肉脂状角膜沉淀物,弥漫性奶油色玻璃体细胞。脑部和眼眶磁共振成像(包括和不包括脂肪饱和的对比)显示右眼脉络膜增厚,多灶性深部脑室周围和深部神经节增强病变,以及鞍上肿块。脑活检显示弥漫性大 B 细胞淋巴瘤。甲氨蝶呤和阿糖胞苷鞘内化疗和全脑放射治疗均失败。他的精神状态恶化。他出现全血细胞减少、中性粒细胞减少性发热和感染性休克,随后在姑息治疗下死亡。