OCCLUSIVE RETINAL VASCULITIS AS A PRESENTING FEATURE OF PRIMARY VITREORETINAL LYMPHOMA RELAPSE.

Abstract

Purpose: The aim of this study was to report a case of primary vitreoretinal lymphoma (PVRL) relapse presenting as occlusive retinal vasculitis with secondary neovascularization.

Methods: This study was a retrospective case report.

Results: A 40-year-old woman presented to the clinic with complaints of blurring of vision in the left eye for 4 months. Her best-corrected VA (BCVA) was 20/20 and 20/500 in the right and left eye, respectively. The vitreous cavities of both eyes showed vitreous opacities (2+). Both eyes fundus showed multifocal yellowish-white subretinal infiltration. A diagnostic vitreous and subretinal biopsy of the left eye revealed large lymphoid cells with CD-20 positivity, confirming the diagnosis of PVRL. The patient received 12 intravitreal methotrexate injections in both eyes over a course of 2 months, after which the lesions completely resolved. However, after 5 months, the left eye showed characteristic subretinal lesions along with perivascular exudates and retinal hemorrhages, diagnosed as PVRL relapse presenting as occlusive retinal vasculitis. Fluorescein angiography revealed retinal neovascularization, for which panretinal photocoagulation was performed along with repeated intravitreal methotrexate injections.

Conclusion: Primary vitreoretinal lymphoma is a great masquerader, and although rare, PVRL relapse can present as occlusive retinal vasculitis with secondary neovascularization, thereby delaying diagnosis and subsequent treatment.