Acute worsening of retinal lesions during oral steroid treatement in a case of intracular lymphoma

Purpose Diagnosis and treatment of intraocular lymphoma remains a clinical challenge. Herein, we present a complicated case in which the diagnosis was made after the acute worsening of retinal lesions during oral steroid treatement. Methods A 49 year old woman complaning of progessive visual acuity decrease was referred with visual acuity of hand movements in the right eye accompanied by vitritis and two peripheral white retinal lesions with vasculitis. Futher examinations excluded the diagnosis of the main causes of infectious and non infectious uveitis and pathological examination of vitreous cells was not compatible with the diagnosis of lymphoma. Results Systemic steroid treatment were given with an initial improvement of the inflammatory conditions. However, a week later an acute worsening of the retinal lesions occured, taking the appearence of a very severe retinal necrosis. Another vitrectomy was thus performed to exclude again infectious causes but was negative for virus and toxo. Finally, the diagnosis of intraocular lymphoma was made on a 3rd diagnostic vitrectomy with retinal biopsy. The patient was treated with a series of intravitreous methotrexate injections followed by chemo- and radiotherapy. Conclusion Systemic administration of corticosteroids in patient with intraocular B lymphoma may lead to dramatic lesion extention preceeded by temporal clinical stabilisation or improvement.