Sequential bilateral optic nerve infiltration as the sole manifestation of relapsed T‐cell lymphoblastic lymphoma: a case report.

Purpose Central nervous system (CNS) involvement in non‐Hodgkin lymphoma (NHL) is well‐known, occurring in approximately 10% of all cases. Among these, infiltrative lymphomatous optic neuropathy (LON) affects 5% usually in the setting of active CNS disease. However, isolated LON in relapsed NHL remains exceptionally rare. Herein, we present a unique case of sequential bilateral optic nerve infiltration as the sole manifestation of relapsed T‐cell lymphoblastic lymphoma. Methods Case report. Results A 30‐year‐old male patient diagnosed as a case of mediastinal T‐cell lymphoblastic lymphoma (LBL).Staging CT confirmed no other site was involved. He received chemotherapy as per protocol. Re‐evaluation with chest CT showed complete resolution of the mass. Five weeks later, the patient presented to private hospital complaining of right eye pain with blurred vision and by the fifth day his vision deteriorated to no light perception. He was diagnosed as relapsed LBL with isolated right optic nerve infiltration and treated accordingly. Two months later, he presented to our center for the first time with left eye pain and blurred vision. Full eye examination revealed blind right eye with no perception of light. Retinal examination for right eye was consistent with combined retinal artery and vein occlusion. Left eye fundus examination revealed gross swelling of the optic disc. Brain MRI showed swollen left optic nerve with no mass occupying lesion. He was treated promptly with radiotherapy and planed for re‐induction chemotherapy. Conclusions Optic nerve infiltration represents an ocular emergency where timely diagnosis and intervention can prevent the irreversible loss of vision. Ophthalmologists should keep high index of suspicion and consider prompt through eye examinations along with brain imaging in patients with history of lymphoma presenting with visual complaints.