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Sona N. Shah, Margaret McDougal Runner, Imtiaz A. Chaudhry, Patricia Chevez-Barrios, Ramsudha Narala, Andrew A Moshfeghi, Michael A. Burnstine, Eric Hamill; Uveal Lymphoma with Concurrent Endogenous Bacterial Endophthalmitis. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1370.
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Independent of one another, endogenous bacterial endophthalmitis (EBE) and uveal lymphoma are extremely rare. Herein, we describe two cases of EBE secondary to group B streptococcus (GBS) in eyes with secondary uveal lymphoma confirmed on histopathology. Understanding the characteristics of these presentations is critical to informing our approach to patients with EBE in the setting of underlying systemic leukemia / lymphoma.
A retrospective review was conducted of two cases who presented with endogenous bacterial endophthalmitis secondary to GBS who underwent evisceration and histopathology confirmed concurrent intraocular manifestation of systemic lymphoma.
A 65-year-old male with a history of a lymphoproliferative disorder treated previously presented with a red, painful left eye and loss of vision. He was found to have endogenous endophthalmitis secondary to GBS bacteremia as determined by blood and vitreous cultures. Evisceration was performed. Histologically, the ocular specimen showed gram positive cocci in pairs in addition to atypical lymphocytic infiltrate in both the uvea and conjunctiva. Tumor cells were positive for CD20 and focally co-expressing CD43 on immunohistochemistry. A diagnosis of bacterial endophthalmitis and extranodal marginal zone B-cell lymphoma involving the uvea and conjunctiva was made. A 70-year-old male with a history of Hepatitis B, facial squamous cell carcinoma, and diabetes mellitus type II, similarly presented with acute, painless vision loss of the left eye, and was also found to have endogenous endophthalmitis secondary to GBS bacteremia as confirmed on blood, anterior chamber and vitreous cultures. Evisceration was performed, and immunohistochemistry of the uveal and retinal tissues was positive for CD20 and CD5, with co-expression of CD23, CD43, and BCL2. The patient was diagnosed with CD5+ small B-cell lymphoproliferative disorder with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) immunophenotype.
To our knowledge, no reports have discussed EBE with concurrent secondary intraocular malignancy. The clinical course of both patients’ EBE was rapidly progressive. It may be that the presence of uveal lymphoma weakens the intraocular immune system and increases the eye’s susceptibility to infection.
This is a 2021 ARVO Annual Meeting abstract.
Figure 1. External photograph of the left eye on presentation (Case 1).
Figure 2. External photographs of the left eye on day 3 (Case 2).
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