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N. Lecuen, H. Elamiri, C. Aknin, N. Cassoux, P. Lehoang, B. Bodaghi; Hodgkin Lymphoma Masquerading as Scleritis or Uveitis. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2994.
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To report clinical features and evolution of ocular manifestations in patients with Hodgkin Lymphoma (HL).
Retrospective observational case series of patients presenting with a biopsy proven HL and ocular manifestations among those seen between 1995 and 2005 at the Ophthalmology Department of Pitié-Salpêtrière Hospital in Paris, France. Clinical and angiographic findings as well as visual prognosis were reviewed.
Five patients with a F/M ratio of 80% were included. Mean age was 36.75 years. All patients had a nodular sclerosis subtype of HL. All patients were referred for the management of scleritis and posterior or panuveitis. Posterior uveitis was present in all cases associated with vitritis and retinal vasculitis. We observed 2 cases of panuveitis and 2 cases of scleritis. Fluorescein angiography showed vasculitis, papillitis and chorioretinal infiltrations. Resistance to high dose corticosteroids was observed in four patients and an extensive work up confirmed the diagnosis of HL with an 8.2 month delay (range from 3 to 13 months). Four patients responded well to specific chemotherapy, leading to long-term remission. Steroid therapy was tapered in alll cases without further recurrence. In one case, symptoms appeared ten months after the diagnostic confirmation of HL. Fundus examination disclosed vitritis, retinal vasculitis, papillitis and chorioretinal scars. Clinical symptoms improved after initiation of corticosteroids. Visual acuity at the end of follow-up was above 20/30 in 4 cases.Ocular manifestations of Hodgkin lymphoma remain nonspecific and can masquerade as scleritis or uveitis. The pathophysiology of the disease remains controversial and may associate direct lymphomatous infiltration and immune-mediated alterations.
Posterior uveitis is the main ocular finding in this case series. Research of HL should be included in the diagnostic work-up of atypical and long-lasting posterior or panuveitis, especially in corticoresistant cases.
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