Two cases of uveitis masquerade syndrome caused by bilateral intraocular large B-cell lymphoma

Abstract

Introduction. Sometimes it is not easy to clinically recognize subtle differences between intraocular lymphoma and noninfectious uveitis. The most common lymphoma subtype involving the eye is B-cell lymphoma. Case report. We presented two patients aged 59 and 58 years with infiltration of the subretinal space with a large B-cell non-Hodgkin intraocular lymphoma. The patients originally had clinically masked syndrome in the form of intermediate uveitis. As it was a corticosteroid-resistant uveitis, we focused on the possible diagnosis of neoplastic causes of this syndrome. During hospitalization, the neurological symptoms emerged and multiple subretinal changes accompanied by yellowish white patches of retinal pigment epithelium with signs of vitritis, which made us suspect the intraocular lymphoma. Endocranial magnetic resonance imaging established tumorous infiltration in the region of the left hemisphere of the cerebellum. The histopathological finding confirmed the diagnosis of large B-cell non-Hodgkin lymphoma of risk moderate degree, immunoblast - centroblast cytological type. The other patient had clinical chronic uveitis accompanied by yellowish shaped white echographic changes of the retina and localized changes in the level of the subretina. The diagnosis of lymphoma was made by brain biopsy. Conclusion. Uveitis masquerade syndrome should be considered in all patients over 40 years with idiopathic steroid-resistant uveitis. Treatment begun on time can affect the course and improve the prognosis of uveitis masquerade syndrome (UMS) and systemic disease.Uvod. Ponekad je tesko ustanoviti suptilnu razlika izmedju intraokularnog limfoma i neinfektivnog uveitisa. Najcesci podtip intraokularnog limfoma je B-celijski limfom. Prikaz bolesnika. Prikazali smo dva bolesnika, starosti 59 i 58 godina, sa infiltracijom subretinalnog prostora velikim B-celijama non-Hodgkin itraokularnog limfoma. Prvi bolesnik prvobitno je imao klinicku sliku maskiranog sindoma u vidu intermedijalnog uveitisa. Kako se radilo o kortikosteroidrezistentnom uveitisu, usredsredili smo se na mogucu dijagnozu neoplasticnog uzroka ovog maskiranog sindroma. U toku hospitalizacije na neurologiji pojavili su se subretinalni eksudati praceni zuckastobelicastim promenama retinalnog pigmentnog epitela i znacima vitritisa koji su nas naveli na sumnju na intraokularni limfom. Magnetna rezonanca (MR) endokranijuma potvdila je infiltraciju leve hemisfere cerebeluma. Patohistoloski nalaz operisanog tumora cerebeluma potvrdio je dijagnozu non-Hodgkin limfoma velikih B-celija, umerenog stepena rizika, imunoblast-centroblastom citoloskog tipa. Drugi bolesnika imao je klinicku sliku hronicnog zadnjeg uveitisa sa zuckasto belicastim promenama retine i ehografski lokalizovanim promenama u nivou subretine. Dijagnoza limfoma postavljena je biopsijom mozga. Zakljucak. Uveitis maskirani sindom (UMS) treba razmotriti kod svih bolesnika starijih od 40 godina sa idiopatskim kortikosteroid-rezistentnim uveitisom. Lecenje zapoceto na vreme moze uticati na tok i poboljsati prognozu UMS i sistemske bolesti.