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Sunju Park, Matthew Katz, David Gritz; Involvement of Vitreous in Castleman’s Disease. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5389.
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To present the first reported patient with Castleman's Disease found to have involvement of the vitreous body.
Case report and review of literature.
A 28-year-old Caribbean-born black woman with known Castleman's Disease presented to the emergency department complaining of frontal headaches for three days. She had been treated several years prior with two rounds of rituximab and her Castleman's Disease was thought to be in remission. Her medical history was also remarkable for recurrent interstitial lung disease and deep venous thromboses and pulmonary emboli necessitating systemic anticoagulation. The patient was evaluated by ophthalmology for a complaint of progressive decrease in vision bilaterally. On examination, best-corrected visual acuity was found to be 20/20 OU. Anterior segment examination was within normal limits. Dilation revealed anterior vitreous cell OU (Figure A) and rare snowballs in the far periphery OS (Figure B). Her posterior segments were otherwise anatomically within normal limits.
Castleman's Disease, or angiofollicular lymph node hyperplasia, is an uncommon and poorly understood lymphoproliferative disorder first described in 1954. This disease entity only rarely involves orbital and ocular structures and infrequently presents with ocular symptoms. Orbital or ocular involvement has been reported in both unicentric and multicentric variants. Previously reported cases have involved the eyelids, lacrimal gland, and the extraocular muscles. Ocular involvement previously reported includes infiltration of the optic disc, chorioretinal lesions, lesions of the retinal pigment epithelium (RPE) with accompanying serous retinal detachment. Ocular symptoms constitute a particularly rare presentation of Castleman's Disease. Patients may complain of diplopia, ptosis, lid swelling, or exophthalmos. Only four previously reported cases reported a decrease in vision. The patient described in this case is the first patient with Castleman’s Disease reported to have involvement of the vitreous body.
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