There's Always a Bigger Fish.

Purpose: To report a rare case of cancer-associated retinopathy (CAR) presenting initially as a bilateral acute vision loss in a 72-year-old female patient with a history of tongue carcinoma. Systemic work-up revealed a metastatic uterine neuroendocrine carcinoma.

Methods: Case report describing clinical presentation and diagnostic work up in a patient with CAR syndrome.

Results: A 72-year-old female patient was referred for bilateral acute severe vision loss immediately after axillary node dissection in the context of a tongue carcinoma. Ophthalmological examination revealed rapidly evolutive outer retinal atrophy, with acute severe vision loss to light perception in both eyes within a few days. CAR-syndrome was suspected in this patient with tongue carcinoma and a positive sentinel lymph node. However, a systemic work-up revealed a metastatic tumor of the uterine body.Despite high-dose systemic corticosteroids, plasmapheresis, and chemotherapy, she did not present any functional recovery.

Conclusion: CAR-syndrome may precede the diagnosis of the associated tumor. Thorough medical history, extensive work-up is the key in order not to miss the primitive lesion causative of the CAR syndrome, even in patients with another known malignancy.