A 42-year-old man came to the emergency department with bilateral and progressive decrease in vision for several weeks.
The patient's personal history included chronic hepatitis C and an autoimmune syndrome of Evans (autoimmune thrombocytopenic purpura with anemia), which had evolved for a long time and required nephrectomy 20 years ago.
Maintenance treatment consisted of 30 mg of oral prednisone every other day.
In exploration, best corrected visual acuity was in RE 0.3 and in LE 0.2.
Biomicroscopically, the patient had a posterior cataract of 1+ in the RE and 2+ in the LE.
Median funduscopy revealed multiple areas of neurosensory detachment and retinal pigment epithelium (RPE) in the posterior pole of both eyes, as well as small whitish lesions in both eyes.
In addition, other pigmented peripheral lesions were found in OS.
Optical coherence tomography (OCT) revealed detachments affecting the macula of both eyes.
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A fluorescein angiography was indicated, which was not performed because two days later the patient was admitted due to high fever, laterocervical lymphadenopathy and persistent diarrhea.
She was treated empirically with cefoxime and corticotherapy, but she presented respiratory distress with progressive deterioration of her general condition.
Median CT scan showed a large mediastinal widening, and cervical lymph node biopsy showed diffuse large B-cell lymphoma with CD20 + marker.
With the diagnosis of diffuse large cell non-Hodgkin B lymphoma in stage II E, 6 cycles of chemotherapy CHOP and rituximab were administered.
Throughout the chemotherapy treatment (especially from the 3rd cycle), the patient has already experienced a clear visual improvement, objectifying the progressive reapplication of all foci of pigment loss.
Six months after the onset of the disease, complete remission of the lymphoma was confirmed by CT and gamma, and the retinas were applied and the old exudative lesions had an exudative chemotherapy appearance.
Median OCT confirmed the resolution of detachments.
The VA was 0.7 in RE and 0.6 in OS and the patient is waiting for cataract surgery.
