Follicular Lymphoma: A Case of Chronic Conjunctivitis with a Surprising Systemic Association

Title Follicular Lymphoma: A Case of Chronic Conjunctivitis with a Surprising Systemic Association
Author, Co-Author Laura Addy, Alyon Wasik
Program Number
Great Hall Foyer
Abstract BACKGROUND Follicular conjunctivitis is a common finding with many relatively benign associated etiologies. Rare cases, however, may be the initial and perhaps only finding in metastases from systemic Non-Hodgkin Lymphoma (NHL). Follicular conjunctivitis is an infrequent manifestation of NHL representing 16% of those with ocular/adnexal involvement. CASE REPORT 47 year old male presented to the eye clinic with a low-grade atypical conjunctival follicular reaction concentrated at the caruncles and inferior palpebral conjunctiva. Because his medical history was positive for NHL, the findings were suspicious for orbital lymphoma. MRI of the brain and orbits did not indicate any mass or evidence of abnormality. There was mesenteric and cervical lymphadenopathy so he was staged at Ann Arbor Stage IV as malignant cells were also discovered in a single extranodal site within the bone marrow. However, given his age and clinical picture, his International Prognostic Index was rated as 1, which is low risk. The oncologist estimated his 5 year survival to be conservatively 73%, and did not recommend treatment, as it would not likely have an effect on survival and he was asymptomatic. Since the ophthalmological findings were consistent with follicular lymphoma, an ocular pathologist was consulted and she determined that biopsy was not indicated as the conjunctivitis was diffuse. The patient continues to be followed on a regular basis by the eye clinic to monitor for ocular complications. He is also under active surveillance by the hematology/oncology service, and still has not required medical nor surgical intervention for indolent NHL. CONCLUSION Although rare, NHL should be considered in the differential diagnosis for chronic follicular conjunctivitis especially if it has an uncharacteristic appearance. Our patient demonstrated this much less-commonly found orbital manifestation which can be an early or potentially the only sign of NHL.
Affiliation of Co-Authors Southern Arizona VA Health Care System