Cabugueira et al., J Clin Case Rep 2015, 5:8 DOI: 10.4172/2165-7920.1000579 Volume 5 • Issue 8 • 1000579 J Clin Case Rep ISSN: 2165-7920 JCCR, an open access journal Open Access Case Report Case Report: Intraocular Non-Hodgkin Lymphoma Ana Cabugueira*, Vanessa Lemos, Marco Dutra Medeiros, Rita Flores and Pinto Ferreira Central Lisbon Hospital Center, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal *Corresponding author: Ana Cabugueira, Central Lisbon Hospital Center, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon; Portugal, Tel: +351 21 371 5600; E-mail: anacabugueira@hotmail.com Received April 25, 2015; Accepted August 06, 2015; Published August 13, 2015 Citation: Cabugueira A, Lemos V, Medeiros MD, Flores R, Ferreira P (2015) Case Report: Intraocular Non-Hodgkin Lymphoma. J Clin Case Rep 5: 579. doi:10.4172/2165-7920.1000579 Copyright: © 2015 Cabugueira A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Purpose: Primary intraocular lymphoma is a primary central nervous system lymphoma in which lymphoma cells invade the retina, vitreous, or optic nerve head without concomitant central nervous system involvement. The aim of this presentation is to report a case of primary intraocular non-Hodgkin lymphoma. Methods: The authors present a case report of a 77 years-old female with painless decreased in visual acuity and foaters. Ophthalmic examination, Static computerized Perimetry, Spectral-Domain Optical Coherence Tomography, angiography, laboratory study, lumbar puncture, computed tomography scan and magnetic resonance imaging were performed. Results: On examination, best corrected visual acuity was 20/25 in the right eye and 30/60 in the left eye. Slip lamp examination revealed anterior chamber reaction and fundoscopy showed vitritis, optic disc edema, macular edema and vasculitis in left eye. After three months of follow-up, the patient’s best corrected visual acuity decreased to 20/60 in right eye and light perception in left eye. Fundoscopy revealed vitritis, optic disc edema, macular edema and vasculitis in both eyes. A granular pattern, leakage from retinal vessels and optic disc were observed in fuorescein angiography. Infectious and infammatory etiologies were excluded. Pars plana vitrectomy and retinal biopsy were performed in left eye. Cytology evaluation revealed atypical lymphoid cells with large nuclei, prominent nucleoli and basophilic cytoplasm, and confrmed the diagnosis of intraocular lymphoma. Conclusion: Intraocular Lymphomas are rare malignancies that display a wide array of clinical manifestation, therefore diagnosis can be challenging. It requires a high degree of clinical suspicion and differential diagnosis includes infectious and non-infectious etiologies. Keywords: Primary intraocular lymphoma; Central nervous system; Fundoscopy; Vasculitis Introduction Primary Intraocular Lymphoma (PIOL) is a rare malignancy of primary Central Nervous System (CNS) without concomitant intracranial involvement. If there was vitreoretinal lymphoma with CNS disease, this is classifed as Primary Central Nervous System Lymphoma (PCNSL) [1]. In PIOL, usually, lymphoma cells invade the retina, vitreous, or optic nerve head whereas secondary intraocular lymphoma predominantly infltrates uveal tract, particularly the choroid. PIOL, usually, presents as a difuse, large B-cell non-Hodgkin’s lymphoma. Te etiology of PIOL and PCNSL are still unknown [1,2]. Te average age in immunocompetent patients is the late 50s and 60s and the rate appears to be increasing dramatically, especially in immunocompromised patients [3]. Te diagnosis is difcult and ofen delay, because it can present with a wide variety of manifestations, that can mimic many ocular conditions [3]. Classic presentation is painless visual acuity decline with foaters and chronic uveitis poorly responsive to corticosteroids [4]. On Slit-lamp examination, anterior chamber cells are presented up to 75% of cases. Te most frequent posterior segment signs are vitritis and classic lesions, such large, multifocal, cream or yellow subretinal infltrates. Tis lesions are considered pathogmonic of this disease. Afer the resolution of this lesions a leopard-spot apperence may be seen. Other manifestations are multiple white dots, retinal infltration, retinal vasculitis, vein and arterial occlusion, fundus favimaculatus- like, exsudative retinal detachment, choroidal involvement, optic disc invasion [5]. Te diagnostic approach includes neurological evaluation, such Computerized Tomography (CT), Magnetic Resonance Imaging (MRI), Lumbar Pucntion (LP) and vitreous or chorioretinal biopsy. 60-80% of patients with PIOL develop cerebral lymphoma and systemic spread is rare, occurring in only 6 to 8% of cases. Te average time separating the onset of ocular symptoms and CNS disease is 29 months [3]. It requires a high degree of clinical suspicion and diferential diagnosis includes infectious and non-infectious etiologies. 6 Optimal treatment for PIOL and PCNSL with ocular involvement is controversial and has yet to be defned. Te aim of our study was to describe a case of a rare malignancy as PIOL and the diagnostic work-up. Case Report Te authors describe a case of a 77 years-old, caucasian female, presented with painless decreased visual acuity and foaters in her Lef Eye (LE) with fve days of evolution. In the frst visit, Best Corrected Visual Acuity (BCVA) was 20/25 on the Right Eye (RE) and 20/60 on the LE. Slit-lamp examination revealed deep anterior chamber with + 2 tyndall. Intraocular pression was 16 mmHg and 15 mmHg in RE and LE, respectively. Fundus examination showed vitritis, optic disc swollen, macular edema and vacuities in the LE (Figure 1). Te patient denied other neurological complains. Systemic and laboratory evaluations including complete blood count, erythrocyte sedimentation rate, C-reactive protein, tuberculin skin test, angiotensin converting enzyme,urine analysis, chest X-ray, Journal of Clinical Case Reports J o u r n a l o f C li n i c a l C a s e R e p o r t s ISSN: 2165-7920