Secondary Intraocular NK/T-Cell Lymphoma

A patient with a history of systemic NK/T-cell lymphoma, previously treated with two rounds of chemotherapy and currently in remission, presented with a six-month history of chronic uveitis in the left eye. She was initially managed with difluprednate drops, but over time, the inflammation became less responsive, and progressive vitritis led to a decline in visual acuity to counting fingers. A diagnostic vitrectomy was performed, revealing a diffuse infiltrate of moderate-sized lymphocytes that were CD3, CD7, and CD56 positive, but CD20 negative, consistent with secondary intraocular involvement of NK/T-cell lymphoma. Although discussion of systemic treatment was discussed, the patient opted for local therapy and received several intravitreal methotrexate injections, which also improved an associated vasculitis that developed secondary to the lymphoma. Subsequently, she developed a right-sided CN VI palsy; however, MRI showed no definitive CNS involvement, and she chose to continue with local treatment alone. Later, she developed a left-sided optic neuropathy, prompting a repeat MRI, which revealed enhancement of the posterior optic nerve, raising suspicion for CNS involvement. A PET-CT scan confirmed findings suggestive of CNS spread of NK/T-cell lymphoma, leading to the initiation of systemic chemotherapy.

Presentation Date: 02/06/2025

Issue Date: 07/25/2025