Rahman Effie Z, Shah Pooja, Shah Rajiv
Department of Ophthalmology, Atrium Health Wake Forest Baptist School of Medicine, Winston-Salem, NC, 27157, USA.
Retina Consultants of Texas, Retina Consultants of America, Bellaire, TX, USA.
Am J Ophthalmol Case Rep. 2023 Sep 28;32:101934. doi: 10.1016/j.ajoc.2023.101934. eCollection 2023 Dec.
To describe a case of retinal and optic nerve metastases masquerading as acute retinal necrosis secondary to primary squamous cell carcinoma of the lung.
A 66-year-old male with a history of Stage IV lung cancer, actively on chemotherapy, presented with right eye vision loss, an afferent pupillary defect, and partial visual field deficiencies. Exam revealed vitritis, macula-involving infiltrative retinitis, optic neuritis, and vasculitis of the right eye. The patient was treated empirically for acute viral retinitis with intravitreal foscarnet and ganciclovir injections and oral acyclovir and trimethoprim-sulfamethoxazole. A diagnostic pars plana vitrectomy with vitreous biopsy, intravitreal antivirals and silicone oil fill was performed. The resulting cytology was positive for malignant squamous cell carcinoma.
We present a unique case of primary squamous cell carcinoma metastasizing to the retina and optic nerve which masqueraded as an acute viral retinitis. To date, there have not been any reported cases on Pubmed or Google Scholar at publication time of known squamous cell carcinoma metastases to the retina that demonstrated interval growth leading to emergent elevations in intraocular pressure (IOP). This case demonstrates the importance of considering metastasis when encountering an atypical acute retinal necrosis case, as well as bring awareness to the possibility that elevated IOP may be the first sign of interval metastases, despite surgical debulking, in cases involving known tumor metastases to the retina.
描述一例因原发性肺鳞状细胞癌伪装成急性视网膜坏死的视网膜和视神经转移瘤病例。
一名66岁男性，有IV期肺癌病史，正在积极接受化疗，出现右眼视力丧失、传入性瞳孔障碍和部分视野缺损。检查发现右眼有玻璃体炎、累及黄斑的浸润性视网膜炎、视神经炎和血管炎。该患者接受了玻璃体内膦甲酸和更昔洛韦注射以及口服阿昔洛韦和甲氧苄啶 - 磺胺甲恶唑的经验性治疗，以治疗急性病毒性视网膜炎。进行了诊断性玻璃体切割联合玻璃体活检、玻璃体内抗病毒药物治疗和硅油填充。结果细胞学检查显示恶性鳞状细胞癌呈阳性。
我们报告了一例原发性肺鳞状细胞癌转移至视网膜和视神经并伪装成急性病毒性视网膜炎的独特病例。截至发表时，在PubMed或谷歌学术上尚未有已知鳞状细胞癌转移至视网膜且显示间隔性生长导致眼压（IOP）急升的报道病例。该病例表明，在遇到非典型急性视网膜坏死病例时考虑转移的重要性，同时也提醒人们注意，在已知肿瘤转移至视网膜的病例中，尽管进行了手术减瘤，但眼压升高可能是间隔性转移的首发迹象。
