Blurred vision as a symptom of Ritcher Syndrome. A case report.

Author: MARIA CRUZ ROJO (Spain)

Co-authors: Francisco Manuel Hermoso Fernandez, Teresa Domech Serrano

Purpose

To describe the importance of evaluating the clinical history and systemic conditions of the patient in the ophtalmology practice, in order to provide proper diagnosis and optimized treatments.

Setting/Venue

Department of Ophthalmology of the San Cecilio University Hospital of Granada, Spain.

Methods

Observational case report. The description of a 68 year old woman case of large cell lymphoma B coroidal metastasis. We portray the findings of the slit- lamp examination and A/B ocular ultrasound previous to other hematology complementary tests. We also used the Pubmed database to find other prospective or restrospective studies.

Results

A 68 year old woman with a history of diffuse large cell B lymphoma in remission since 2012, with a subsequent relapse as small chronic lymphatic leukemia in 2020, managed with expectant attitude and vigilance, presented with a chief complaint of sudden blurry vision in her right eye without a history of trauma. The best corrected visual acuity (BCVA) was OD =6/15, and the slit-lamp examination revealed Tyndall 3++ with a difficult fundus examination due to a bad inferior mydriasis and media opacity. Treatment with dexamethasone eye drops and cycloplegic was prescribed. In the following appointment, the visual acuity worsens to OD=hand motion and the slit- lamp examination reveals an haematic Tyndall 3+ with an hiphema of the lower third of the anterior chamber with an impossible exploration of the fundus due to media opacity. An A/B ocular ultrasound is performed revealing a thickened hyperechogenic and homogeneous inferior choroid mass. The patient is referred to the Hematology service, who proceeded to the confirmation, after several complementary tests, of a transformation from the chronic lymphatic leukemia to diffuse large cell lymphoma B (Ritcher syndrome) stage IV due to orbital and bone marrow involvement, proposing chemoterapy and triple intrathecal therapy

Conlusions

'- Clinical features of a choroid metastasis from lymphoma may masquerade as uveitis. The evaluation of the fundus of the eye is of vital importance when presenting with this condition. - In the study of a choroidal mass, it is of utmost importance that the personal clinical history and systemic conditions are taken into account, in order to provide optimized treatments as they are directed towards the primary tumor. - Close multidisciplinar collaboration is essential for the proper diagnosis and treatment of patients with history of hematological conditions.

Financial Disclosure

NONE