ePoster

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Title:

Unilateral chronic uveitis in a patient with testicular and central nervous system lymphoma

Poster Details

First Author: G. Satirtav TURKEY

Co Author(s):    G. Bitirgen                    

Abstract Details

Purpose:

To describe a 56-year-old male patient presenting with a complaint in decrease of vision in his left eye for about 4 months. Visual acuity (VA) was 10/10 in the right eye and 2/10 in the left eye. On biomicroscopic examination, there was panuveitis of the left eye with the right eye being normal. His medical history was unremarkable without any ocular injury, previously known systemic disease or surgery.

Setting:

Necmettin Erbakan University Meram School of Medicine Ophthalmology Department

Methods:

Etiological investigations were unremarkable including complete blood cell count, antinuclear antibodies, VDRL for syphilis and PPD for tuberculosis. Cytologic examination of vitrectomy specimen was reported as negative for malignancy. Cranial magnetic resonance imaging ruled out central nervous system lymphoma. Topical and subconjunctival dexametasone was administered. At first month of treatment, VA was 9/10 in the left eye and the vitritis resolved. After two months, vitreal inflammation recurred and VA decreased to counting fingers with no response to intravitreal dexamethasone implant. Vitrectomy was performed and vitreal sample was reported to be negative for malignancy, bacterial and fungal agents.

Results:

Eight months after the initial examination, the patient returned with diffuse large B cell lymphoma of the testis. Neurological symptoms and seizures were also noted and detailed examinations and neuroimaging revealed cranial involvement associated with lymphoma. Malign lymphoma cells were identified in the cerebrospinal fluid. Orchiectomy with intrathecal methotrexate and systemic chemotherapy was administered. Two months after the treatment, the ocular examination revealed VA of 1/10 and nuclear cataracts with no remarkable vitritis or retinal lesions.

Conclusions:

The testis, brain and eye are all considered as immunoprivileged sites, where strong blood-tissue barriers as altered immune response allows cells including certain malignant cells expressing non-self antigens to escape destruction by the immune system. There have been documented cases of primary testicular lymphoma relapsing in the eye. Our case presented with early ocular involvement before testicular and central nervous system features.

Financial Disclosure:

None