Hemorrhagic hypopyon, feature of intravascular lymphoma

By
Dr. Aiman Shahab
-
0
Hemorrhagic hypopyon
a Hemorrhagic hypopyon can be seen resting in the anterior chamber. bThe herpetic corneal dendrites and opacity can be seen on the corneal surface via fluorescein staining. c A magnified image reveals the hemorrhagic hypopyon (bottom arrow) and fibrin deposits (top arrow) more clearly. d Anterior segment OCT demonstrates the accumulating hypopyon (red arrow) and fibrin deposition (white arrow). e A fluorescein staining of the cornea demonstrating herpetic dendrites and corneal opacity at the time of recurrence 3 months after initial admission

Hemorrhagic hypopyon

Hyphema is a commonly reported presentation of herpes uveitis. Whereas hemorrhagic hypopyon is rarely reported secondary to herpes uveitis. However, that wasn’t the case for a 62-year-old Japanese woman with rheumatoid arthritis and HSV uveitis.

H/O Primary RA and Sjogren Syndrome

The 62-year-old was referred for bilateral dry eyes. The Schirmer’s test result was 0 mm for both eyes. She had been diagnosed of primary rheumatoid arthritis and secondary Sjogren syndrome four years ago.

Her CT scans were normal during her first diagnosis of RA. Prior to her dry eyes’ referral, her previous hospital found CRP and LDH levels to be raised significantly, which led to the suspicion of any underlying malignancy. Lung opacities were found in the CT scan.

While she was being treated for the dry eye, she presented with hemorrhagic hypopyon in the anterior chamber, with fever and photophobia, for which she had been admitted to the hospital. 

Hemorrhagic hypopyon showed niveau-like hypopyon with hemorrhage. A distinct herpetic corneal lesion was also noted with fluorescein staining. No synechiae was noted. However, keratic precipitates were. HSV was identified in the right eye.

Treatment and Diagnosis

She was treated with antiviral drugs. It improved the corneal lesions and hyphema. Unfortunately, the lesion recurred after three months, which led to suspicion of an additional hypopyon including pathology.

Since there was a history of lung opacities and elevated LDH, lung biopsy was done next, which eventually diagnosed intravascular lymphoma. She was treated of lymphoma, which resolved the ocular symptoms completely and no recurrence was seen as of 1.5 years later.

The rare presentation of hemorrhagic hypopyon could have enabled the interaction of the HSV with intravascular lymphoma. The dendritic lesions, IgG assay, response to antiviral drugs indicated the involvement of HSV. Furthermore, when anti-tumor drugs resolved all ocular symptoms, the indication of lymphoma seemed to be evident. 

References

Hemorrhagic hypopyon as presenting feature of intravascular lymphoma, a case report https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5657083/

Previous articleCase of Iatrogenic Endometriosis
Next articleBenign meningioma manifesting with acute subdural hematoma and cerebral edema
Dr. Aiman Shahab
Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.

RELATED ARTICLESMORE FROM AUTHOR

LEAVE A REPLY

Please enter your comment!
Please enter your name here