Systemic Diffuse Large B-Cell Lymphoma Presenting as Bilateral Orbital Vasculopathy

The authors report a case of a 58-year-old man with bilateral proptosis and signs of orbital inflammation without any associated systemic findings. MRI showed diffuse orbital infiltration. An intraconal orbital biopsy revealed polyclonal lymphoplasmacytic infiltration and non-necrotizing lymphoid small-vessel vasculopathy. The orbital symptoms resolved following a 2-week course of oral prednisone. Three months later, the patient experienced abdominal pain and weight loss. Ultrasonographic investigation showed hepatosplenomegaly, a retroperitoneal mass, and inguinal lymphadenopathy. A lymph node biopsy revealed a diffuse large B-cell lymphoma. The patient underwent chemotherapy but died 6 months later with metastatic disease. This case suggests that diffuse orbital inflammation with nonspecific vasculitis may be an early paraneoplastic finding associated with diffuse large B-cell lymphoma. Accepted for publication September 27, 2018. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Antonio A. V. Cruz, MD, Department of Ophthalmology, Hospital das Clínicas de Ribeirão Preto-CAMPUS, School of Medicine of Ribeirão Preto - University of São Paulo, Av Bandeirantes 3900, 14049–900, Ribeirão Preto, SP, Brazil. E-mail: aavecruz.fmrp@gmail.com. © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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