Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
Haematology Unit, Department of Internal Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
Ocul Immunol Inflamm. 2021 Apr 3;29(3):479-484. doi: 10.1080/09273948.2020.1800050. Epub 2020 Sep 24.
A 45-year-old man was diagnosed with diffuse large B-cell lymphoma stage IV which was confirmed by celiac lymph node biopsy. He subsequently completed six cycles of R-CHOP chemotherapy. Six months later, he presented with panuveitis OU with positive relative afferent pupillary defect OD. OCT revealed hyper-reflective lesions and irregularity of the retinal pigment epithelium OU. Fundus fluorescein angiogram shows hyper-auto fluorescence and granular changes on the retina. A month later, he developed swollen optic disc OD and hemorrhagic retinitis OU and treated as presumed CMV retinitis. Anti-TB was started after a positive Mantoux test. He finally consented for a vitreous biopsy which showed atypical lymphoid cells highly suggestive for vitreoretinal lymphoma and subsequently received intravitreal methotrexate OU. Optic nerve infiltration in systemic metastatic retinal lymphoma may have initial occult signs but with profound visual loss. Ocular infections like CMV retinitis and tuberculosis may mask and delay the diagnosis in immunocompromised patients.
一位 45 岁男性被诊断为弥漫性大 B 细胞淋巴瘤 IV 期，这一诊断通过腹腔淋巴结活检得到了确认。随后，他完成了六个周期的 R-CHOP 化疗。六个月后，他出现双眼全葡萄膜炎，右眼出现阳性相对性传入性瞳孔障碍。OCT 显示双眼视网膜色素上皮的高反射病变和不规则。眼底荧光血管造影显示视网膜呈高自发荧光和颗粒状改变。一个月后，他的右眼视盘肿胀，双眼出现视网膜出血，被诊断为疑似 CMV 性视网膜炎。在结核菌素试验阳性后，开始进行抗结核治疗。他最终同意进行玻璃体活检，结果显示为典型的淋巴样细胞，高度提示为玻璃体视网膜淋巴瘤，随后他接受了双眼玻璃体内注射甲氨蝶呤。全身转移性视网膜淋巴瘤累及视神经可能最初没有明显的迹象，但会导致严重的视力丧失。在免疫功能低下的患者中，眼部感染（如 CMV 性视网膜炎和结核病）可能会掩盖和延迟诊断。
