Immune recovery uveitis-like syndrome mimicking recurrent T-cell lymphoma after autologous bone marrow transplant

Jeremy A. Lavine, Arun D. Singh, Kimberly Baynes, Sunil K. Srivastava*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Purpose:To report the multimodal imaging findings of immune recovery uveitis mimicking recurrent T-cell lymphoma after autologous bone marrow transplant therapy.Methods:A 71-year-old man presented with posterior uveitis 6 weeks after chemotherapy and autologous bone marrow transplant for angioimmunoblastic T-cell lymphoma. Multimodal imaging included fluorescein angiography, fundus autofluorescence, and optical coherence tomography. Diagnostic testing included ocular polymerase chain reaction and diagnostic vitrectomy.Results:Clinical examination demonstrated vitritis and perivascular deep retinal whitening. Imaging of the retinal whitening showed late hyperfluorescence on fluorescein angiography, hyperautofluorescence on fundus autofluorescence, and ellipsoid zone loss on optical coherence tomography without infiltrative lesions. Testing was negative for syphilis, herpes simplex virus, varicella-zoster virus, and cytomegalovirus. After no clinical improvement with valacyclovir and intravitreal foscarnet treatment, diagnostic vitrectomy was performed. Bacterial and fungal cultures were negative, and herpes simplex virus, varicella-zoster virus, and cytomegalovirus were not detected by polymerase chain reaction. Cytopathology showed mature small nonneoplastic lymphocytes, macrophages, and monocytes. Flow cytometry demonstrated a reactive T-cell population. The patient demonstrated clinical improvement over time with spontaneous resolution of all retinal findings.Conclusion:This case most likely represents immune recovery uveitis-like syndrome. Diagnostic vitrectomy is highly valuable when the differential includes inflammatory, infectious, and neoplastic processes.

Original languageEnglish (US)
Pages (from-to)407-411
Number of pages5
JournalRetinal Cases and Brief Reports
Volume15
Issue number4
DOIs
StatePublished - Jul 1 2021

Keywords

  • angioimmunoblastic T-cell lymphoma
  • autologous bone marrow transplant
  • fluorescein angiography
  • fundus autofluorescence
  • immune recovery uveitis
  • optical coherence tomography
  • posterior uveitis

ASJC Scopus subject areas

  • Ophthalmology

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