Primary ocular Epstein-Barr virus-associated non-Hodgkin's lymphoma in a patient with AIDS - A clinicopathologic report

Objective: To report an unusual case of chronic multifocal chorioretinitis with vitritis in a patient with acquired immunodeficiency syndrome (AIDS) t hat was resistant to antiviral and antitoxoplasmic medication and required a retinal biopsy for definitive diagnosis. Methods: Vitreous biopsy, pars plana vitrectomy, and retinal biopsy were pe rformed. The vitreous biopsy material was sent for bacterial, fungal, and v iral culture, and the vitreous cassette was sent for cytology. The retinal biopsy material was divided and sent for polymerase chain reaction testing for toxoplasmosis and virology and pathologic tissue analysis. Results: Vitreous cytology showed a mixed population of lymphocytes and his tiocytes, but all other microbiologic and virologic studies were negative. Tissue analysis revealed an infiltrate of atypical mononuclear cells extend ing from the inner limiting membrane through the outer plexiform layer char acteristic of a B cell, non-Hodgkin's lymphoma of the central nervous syste m (NHL-CNS). In situ hybridization for the Epstein-Barr virus (EBV) was pos itive. An extensive systemic evaluation did not show evidence of extraocula r tumor. Conclusion: Although rare, primary ocular NHL-CNS can be seen in patients w ith AIDS, and its clinical presentation often closely resembles other disor ders. To our knowledge, this case represents the first ocular NHL in which EBV is shown to be associated.