Primary Intraocular Lymphoma Masquerading as Unilateral Hypopyonic Anterior Uveitis: A Case Report

Purpose: To report an unusual case of unilateral anterior segment large B-cell intraocular lymphoma (IOL) presenting as a recurrent hypopyonic anterior uveitis Case Presentation: A 55-year-old female was referred because of recurrent unilateral anterior hypopyonic uveitis with partial response to topical corticosteroid. All of the laboratory tests, review of systems and ocular sampling results were unremarkable. Finally, with probability of masquerading syndromes cytological specimens were obtained 3 times and the last sample showed large B cell lymphoma. However, posterior segment of the eyes has never involved during 18 months’ follow-up. First, it appeared confined to the eye and initially responded favorably to local chemotherapy (methotrexate and rituximab) but later went on to develop systemic involvement. CNS lymphoma was detected in the third brain MRI 6 months following ocular involvement. At this time, systemic chemotherapy was started. In the last 18 months’ follow-up, visual acuity was 20/30 in the right eye without posterior segment or fellow eye involvement. Conclusion: Unusual presentation of PIOL as a unilateral isolated anterior hypopyonic uveitis should be kept in mind. This report emphasizes the importance of precise work-ups and multiple ocular biopsies to confirm the diagnosis of intraocular lymphoma.