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Titel

Bifocal Optic and Facial Nerve Infiltration with intraocular spread in Systemic T cell Lymphoma

Doel	To report an extremely rare case of biopsy proven infiltration of the optic nerve (ON), its sheath, the eye and the facial nerve (FN), without central nervous system (CNS) involvement, in a patient with systemic T cell lymphoma.
Methodes	A complete clinical work-up was performed, followed by an optic nerve biopsy. Histopathology and immunohistochemistry on the biopsy specimen confirmed the diagnosis of T cell lymphoma. A thorough systemic workup ruled out additional locations elsewhere.
Resultaten	A 63 year old female with systemic T cell lymphoma in clinical remission presented with loss of vision and pain in the left eye (LE). She had initially been treated for presumed recurrent optic neuritis. Best corrected visuel acuity was no perception of light in the LE. Fundoscopy showed significant optic disc edema and a large peripapillary, subretinal infiltration. MRI of the brain and orbit showed thickening and contrast enhancement of the entire left ON and temporal aspect of the right FN. ON biopsy showed a necrosis and infiltration with CD3 positive lymphocytes. A complete systemic workup revealed no evidence of disease elsewhere.
Conclusie	Optic nerve infiltration from systemic lymphoma is rare and generally occurs with central nervous system involvement. However, a bifocal pattern of recurrence from systemic T cell lymphoma involving the right facial nerve and left optic nerve is possible.

Auteur 1

Naam	VAN HOEY
Initialen	A
Instituut	Dept of Opththalmology, Ghent Univ Hosp
Stad	Ghent

Auteur 2

Naam	Shah
Initialen	A
Instituut	Dept of Opththalmology, Ghent Univ Hosp
Stad	Ghent

Auteur 3

Naam	De Zaeytijd
Initialen	J
Instituut	Dept of Opththalmology, Ghent Univ Hosp
Stad	Ghent

Auteur 4

Naam	Leroy
Initialen	BP
Instituut	Dept of Opththalmology & Ctr for Medical Genetics, Ghent Univ Hosp
Stad	Ghent

Auteur 5

Naam	Decock
Initialen	C
Instituut	Dept of Opththalmology, Ghent Univ Hosp
Stad	Ghent