Intraocular Lymphoma or Infection? Subretinal Aspirate Confirms the Diagnosis

A Saad,A Aboushrkh,S O Salceanu,D Hamada,K Oswal

doi:10.1155/2018/6437603

Abstract

Purpose To demonstrate the importance of subretinal biopsy to reach a diagnosis when vitreous biopsy is negative or inconclusive. Methods A 54-year-old Caucasian gentleman presented with bilateral anterior uveitis at JCUH. He initially responded to topical steroids and dilating agents. Subsequently he developed bilateral panuveitis and cataract with poor response to treatment. Detailed workup had been done to rule out infectious etiology. A suspicion of lymphoma was considered and vitreous biopsy sample was taken from one eye, which was inconclusive. Then, to help with definitive diagnosis vitreous sample, subretinal aspirate and retinal biopsy were taken. Results Subretinal aspirate revealed Aspergillus niger. Treatment was initiated accordingly. Conclusions Subretinal aspirate and retinal biopsy can help with diagnosis of unusual clinical panuveitis like presentation.

Highlights

Anterior uveitis, posterior uveitis, and panuveitis are most commonly diagnosed, investigated, and managed medically
We present a rare case of panuveitis, where vitreous biopsy did not yield conclusive results, but subsequent subretinal aspirate grew a microbe!
Boldrey EE reported bilateral Aspergillus eye infection from metastatic heart valve infection [1]. This case was treated with vitrectomy and amphotericin B injection

Summary

Introduction

Posterior uveitis, and panuveitis are most commonly diagnosed, investigated, and managed medically. Surgical interventions such as vitreous biopsy are occasionally necessary to aid in diagnosis and management of panuveitis. We present a rare case of panuveitis, where vitreous biopsy did not yield conclusive results, but subsequent subretinal aspirate grew a microbe! (v) B scan showed diffuse choroidal thickening with mild exudative detachment and a diagnosis of lymphoma was considered (Figures 2(a) and 2(b), right eye and left eye, resp.).

Results

Conclusion