Inverse Argyll Robertson pupil in Burkitt′s lymphoma

We present a case of an 18 year old white male with Burkitt's lymphoma who was operated on for hydrocephalus and subsequently referred for evaluation of new onset diplopia. On examination, his visual acuity (VA) was 20/20 in both eyes with a right superior oblique palsy. His pupillary reaction to light was intact while on near gaze there was no constriction of the pupils, bilaterally. The other two responses of the near gaze triad ie, convergence and accommodation were present. These findings were suggestive of an Inverse Argyll Robertson pupil (IARP), a rare entity in the literature. We could not find a specific cause attributable to this manifestation in this patient, though we feel it may be secondary to infiltration from Burkitt's lymphoma and/or compression from elevated intracranial pressure of the efferent pupillary near reflex pathway.