Optic nerve infiltration as an initial manifestation of t-cell lymphoma's relapse

Direct invasion of the orbit by the neoplastic cells from systemic T-cell non-Hodgkin’s lymphoma is common. However, optic nerve involvement as an initial manifestation of relapsed disease is relatively rare. A 13-year old boy with systemic T-cell non-Hodgkin’s lymphoma at stage IV in remission complained of progressive visual loss in his left eye. Ophthalmoscopy detected left optic disk edema and retinal venous engorgement. Magnetic resonance imaging showed evidence of left optic nerve head infiltration. Optical coherence tomography indicated swollen left optic nerve head. A unilateral optic nerve infiltration as an initial isolated presentation of T-cell non-Hodgkin’s lymphoma relapse was diagnosed. The patient underwent systemic chemotherapy and whole brain radiotherapy of both orbits. Incomplete recovery of his left eye visual acuity was reported. Unfortunately, the child died of systemic relapse 5 months later. The rare optic nerve infiltration as an initial manifestation of T-cell lymphoma’s relapse requires urgent investigation and treatment. Scripta Scientifica Medica 2012; 44(2): 93-95.