Intraocular involvement of T-cell lymphoma presenting as inflammatory glaucoma, neurotrophic keratopathy, and choroidal detachment

• Published in: Journal of the Chinese Medical Association 2014-07, Vol.77 (7), p.385-388
• Main Authors: Lin, Tai-Chi, Lin, Pei-Yu, Wang, Lei-Chi, Chen, Shih-Jen, Chang, Yu-Mei, Lee, Shui-Mei
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Choroid Diseases - etiology; choroidal detachment; Corneal Diseases - etiology; Cytomegalovirus; Eye Neoplasms - secondary; Glaucoma - etiology; Herpes simplex virus 1; Humans; inflammatory glaucoma; Internal Medicine; intraocular T-cell lymphoma; Lymphoma, T-Cell - complications; Lymphoma, T-Cell - pathology; Male; neurotrophic keratopathy; Neutrophils - pathology; uveitis; Varicella-zoster virus
• ISSN: 1726-4901; 1728-7731
• DOI: 10.1016/j.jcma.2014.04.002

Abstract Intraocular involvement of T-cell lymphoma is rare. We report a case presented with inflammatory glaucoma, neurotrophic keratopathy, and choroidal detachment. An 81-year-old man presented with unilateral high intraocular pressure and keratic precipitates. Polymerase chain reaction of the aqueous humor was negative for herpes simplex virus type 1 and 2, varicella zoster virus, and cytomegalovirus. Progressive pupil dilatation, cornea anesthesia with large epithelial defect, and choroidal detachment were noted in the following month. Diagnostic vitrectomy was then performed, and cytology of the vitreous suggested malignant lymphoma. Further systemic workup revealed ulcerative lesions in the stomach, and biopsy with special stains led to the diagnosis of peripheral T-cell lymphoma of the stomach with ocular involvement. Intraocular involvement of T-cell lymphoma is very rare. Most typically, the skin, followed by the central nervous system, has the most frequently occurring concurrent systemic involvement. In fact, stomach involvement has not been reported. Most cases of intraocular lymphomas presented with vitritis and anterior uveitis, and elevated intraocular pressure was not commonly observed. A review of the literature indicates that a large corneal epithelium defect has been described only in a case of peripheral T-cell lymphoma with the involvement of sclera and oropharynx. Although very rare, inflammatory glaucoma, neurotrophic keratopathy, and choroidal detachment can be the initial presentation of intraocular involvement of T-cell lymphoma.