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Steroid-induced delayed diagnosis of primary vitreoretinal lymphoma with ghost brain tumor: A case report

Primary vitreoretinal lymphoma is a great masquerader and provides a diagnostic challenge. It is most frequently misdiagnosed as a chronic uveitis. Steroid treatment for presumed uveitis can interfere with the correct diagnosis of vitreoretinal lymphoma. Herein, we present a case of primary vitreore...

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Detalles Bibliográficos
Autores principales: Kau, Hui-Chuan, Wang, Cheng-Jen, Tsai, Chieh-Chih
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9302244/
https://www.ncbi.nlm.nih.gov/pubmed/35866822
http://dx.doi.org/10.1097/MD.0000000000029637
Descripción
Sumario:Primary vitreoretinal lymphoma is a great masquerader and provides a diagnostic challenge. It is most frequently misdiagnosed as a chronic uveitis. Steroid treatment for presumed uveitis can interfere with the correct diagnosis of vitreoretinal lymphoma. Herein, we present a case of primary vitreoretinal lymphoma in which the correct diagnosis was delayed by short-term steroids until 2 years later. PATIENT CONCERNS: A 45-year-old woman presented with floaters and blurred vision in her right eye for 3 months. An ocular examination revealed dense vitreous cells. Three months later, she developed headache and suicidal ideation after taking a 3-week medication of oral steroid medication from another eye clinic. Brain magnetic resonance imaging revealed a tumor involving the corpus callosum and periventricular region. INTERVENTIONS: Vitreous biopsy and repeated brain biopsies were carried out for the patient. DIAGNOSIS: A brain biopsy was performed for the first time, and a vitreous biopsy was performed when steroid medication was suspended for 20 and 41 days, respectively. Both biopsies were negative for the presence of malignant cells. Follow-up magnetic resonance imaging revealed complete remission of the brain tumor. Two years later, the tumor recurred in the optic chiasm. Diffuse large B-cell lymphoma was confirmed by a second brain biopsy. OUTCOME: The patient had complete tumor remission after receiving brain radiation therapy and chemotherapy. LESSONS: Vitreoretinal lymphoma is difficult to diagnose owing to its rarity, masquerading presentation, and steroid-induced apoptosis of lymphoma cells. Physicians should consider vitreoretinal lymphoma as an important differential diagnosis in patients presenting with chronic uveitis and use steroids cautiously before making a definitive diagnosis.