Multifocal nodular episcleritis and scleritis with undiagnosed Hodgkin's lymphoma

Manoj M. Thakker, Victor L. Perez, Alexandre Moulin, Sandra L. Cremers, C. Stephen Foster

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

Purpose: To report the case of a patient with undiagnosed Hodgkin's lymphoma who presented with coexistent unilateral nodular episcleritis and scleritis. Design: Interventional case report and literature review Methods: Review of clinical history, laboratory findings, histology of episcleral and cervical lymph node biopsies, and follow-up. Results: A 20-year-old female presented with a 5-month history of redness and pain in her left eye, with associated symptoms of dyspnea, malaise, and fever. The patient was found to have multifocal nodular episcleritis and scleritis that was not responsive to topical steroids or systemic nonsteroidal anti-inflammatory treatment. Laboratory tests subsequently revealed evidence of systemic inflammation, and radiologic studies showed extensive mediastinal and cervical adenopathy. A cervical lymph node biopsy showed Reed-Sternberg cells and a chronic lymphocytic infiltrate consistent with nodular sclerosing Hodgkin's lymphoma. Histopathologic analysis of an episcleral nodule revealed a necrotizing granuloma with vasculitis. Systemic chemotherapy was instituted for the Hodgkin's disease; this therapy abolished the nodular scleritis. Conclusions: This case raises the possibility of concurrent undiagnosed systemic vasculitis with only an ocular manifestation with Hodgkin's lymphoma, either as a coincidence or as a paraneoplastic syndrome. Moreover, it emphasizes the important role of tissue biopsy in establishing diagnosis and directing treatment.

Original languageEnglish (US)
Pages (from-to)1057-1060
Number of pages4
JournalOphthalmology
Volume110
Issue number5
DOIs
StatePublished - May 1 2003

ASJC Scopus subject areas

  • Ophthalmology

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    Thakker, M. M., Perez, V. L., Moulin, A., Cremers, S. L., & Foster, C. S. (2003). Multifocal nodular episcleritis and scleritis with undiagnosed Hodgkin's lymphoma. Ophthalmology, 110(5), 1057-1060. https://doi.org/10.1016/S0161-6420(03)00090-3