AIDS-ASSOCIATED INTRAOCULAR LYMPHOMA CAUSING PRIMARY RETINAL VASCULITIS

Background: There is an increasing association between ocular-central nervous system (CNS) lymphoma and the acquired immunodeficiency syndro me (AIDS). In this population, the disease generally occurs in a young er age group. The origin of these B-cell neoplasms remains unknown. Me thod: Case study of a 26-year-old AIDS patient with an incidental find ing of localized retinal vasculitis and local vitritis. Disease progre ssion and the failure of antiviral therapy led to early diagnostic vit rectomy with vitreal and retinal biopsy. Cerebrospinal fluid (CSF) eva luation, head magnetic resonance imaging (MRI), and brain biopsy were performed. Results. The diagnosis of ocular non-Hodgkin lymphoma was m ade by vitreous cytology. Serial sectioning of a retinal biopsy showed no retinal neoplastic infiltration, only perivascular inflammatory ce lls. CSF was normal. MRI showed multicentric brain mass lesions that e nhanced with intravenous contrast. Brain biopsy revealed an immunoblas tic, angiocentric, B-cell non-Hodgkin lymphoma. The patient died withi n two months, despite cerebral and ocular irradiation. Conclusions: Th e segmentally localized retinal vasculitis-vitritis and absence of ret inal infiltration suggested early primary involvement of the vitreous. Coarse perivascular sheathing is characteristic of the mixed retinal vasculitis in this disease. The diagnosis of ocular-CNS lymphoma must be considered in patients with AIDs, however young, with unexplained p osterior segment inflammatory disease or subretinal masses.