Optic nerve infiltration as a significant feature in the treatment of a rare secondary intraocular lymphoma derived from a primary breast B-cell lymphoma: A case report

Abstract

Intraocular lymphoma (IOL) is a rare form of lymphocytic malignancy which may pose a significant diagnostic challenge as it may masquerade various uveitis entities, with secondary IOL being less common than primary IOL. A 47-year-old woman presented with blurring of the right eye and floaters since 5 months before admission. She had a history of complete remission from primary breast diffuse large B cell lymphoma for five consecutive years. Both eyes had vitreous haziness and several yellowish, thickened retinal lesions with edematous and infiltrated optic nerves. The best-corrected visual acuity was hand movement for the right eye and 6/45 for the left eye. Cytopathologic exam of the vitreous showed a B cell origin lymphoma. Cerebral magnetic resonance imaging revealed new parenchymal lesions suggestive of metastatic lesions. The patient was given multiple rituximab intravitreal injections and systemic chemotherapy. Treatment options for IOL might be influenced by the central nervous system (CNS) involvement, which is signified by infiltration of the optic nerve in this case.