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Case Reports
. 2017 Oct 25;17(1):195.
doi: 10.1186/s12886-017-0591-3.

Hemorrhagic hypopyon as presenting feature of intravascular lymphoma, a case report

Andrew Winegarner  1 , Noriyasu Hashida  2 , Shizuka Koh  1 , Kohji Nishida  1
Affiliations
Case Reports

Hemorrhagic hypopyon as presenting feature of intravascular lymphoma, a case report

Andrew Winegarner et al. BMC Ophthalmol. .

Abstract

Background: Herpes uveitis has been previously reported to present with hyphema, but hemorrhagic hypopyon is rarely reported as a herpetic uveitis manifestation. We report a case of herpes simplex virus (HSV) presenting with hemorrhagic hypopyon, and speculate on the underlying pathophysiology with relation to an intravascular lymphoma which was subsequently diagnosed as a result.

Case presentation: We present a case wherein a 62-year-old Japanese rheumatoid arthritis woman, with HSV uveitis, presented with hemorrhagic hypopyon in the anterior chamber and a fever with photophobia. Patient was treated with antiviral drugs which improved the hyphema and corneal lesions, but lesions recurred 3 months later. This rare presentation of HSV induced uveitis, and its subsequent recurrence, aroused suspicion of an additional hypopyon-inducing pathology. On account of previous history of lung opacities and elevated LDH, intravascular lymphoma was eventually diagnosed via lung biopsy. She was treated for the lymphoma which also completely resolved all ocular symptoms without any recurrence as of 1.5 years later.

Conclusion: The exceedingly rare presentation of hemorrhagic hypopyon may have been enabled by an interaction of the HSV with the intravascular lymphoma. HSV involvement was indicated by the dendritic lesions, IgG assay, and response to anti-viral drugs. The ocular involvement of the intravascular lymphoma seems to be indicated by virtue of the anti-tumor drugs completely resolving all ocular symptoms.

Keywords: Case report; Hemorrhagic hypopyon; Herpes simplex uveitis; Intravascular lymphoma; Ophthalmic manifestations; Vessel permeability.

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Conflict of interest statement

Ethics approval and consent to participate

The Institutional Review Board of the Osaka University Medical School approved the research protocol, and the procedures conformed to the tenets of the Declaration of Helsinki.

Consent for publication

Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
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
Fig. 2
Fig. 2
a A CD3 stain of the lung biopsy reveals no T cell involvement. b A CD20 stain reveals heavy staining within the lumen and alveoli, indicating a B cell lymphoma. c H&E stain demonstrates lymphocytic infiltration along the alveoli and in the lumen. d CD79 stain further confirms heavy involvement of B cells indicating the intravascular lymphoma is of B cell origin
Fig. 3
Fig. 3
a Slit lamp photograph from 1.5 years post treatment reveals no hypopyon. b Corneal fluorescein staining demonstrated no significant opacification or herpetic lesion
See this image and copyright information in PMC

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