A case of intraocular lymphoma with central nervous system involvement and high interleukin-10 levels in both vitreous humor and cerebrospinal fluids: successful treatment with a combination of intravitreal, intrathecal, and systemic therapy

Abstract

A 70-year-old man with diffuse large B cell lymphoma, who had been in complete remission without treatment, presented with a visual disorder in the right eye. Vitreous biopsy was performed, although the results were not typically suggestive of lymphoma. The concentration of interleukin-10 (IL-10) in the vitreous humor was markedly elevated, suggesting intraocular lymphoma (IOL). Weekly intravitreal injections of methotrexate (MTX) resulted in remission of the visual disorder. During this remission, 10 months after the last intravitreal MTX treatment, a cerebral tumor was observed in the corpus callosum and atypical lymphocytes were detected in the cerebrospinal fluid. The concentration of IL-10 in the CSF was markedly elevated and the IL-6 level was slightly elevated, suggesting central nervous system (CNS) involvement. The patient was treated with intrathecal MTX, systemic rituximab, high-dose cytarabine, and high-dose methotrexate. After this therapy, the cerebral tumor disappeared, atypical lymphocytes were undetectable in the CSF, and the CSF IL-10 level was significantly reduced. IL-10 and IL-6 concentrations in the vitreous humor and CSF are important for diagnosis of IOL with CNS involvement and for monitoring the efficacy of therapy.