Multifocal nodular episcleritis and scleritis with undiagnosed Hodgkin's lymphoma.
OBJECTIVE
To report the case of a patient with undiagnosed Hodgkin's lymphoma who presented with coexistent unilateral nodular episcleritis and scleritis.


METHODS
Interventional case report and literature review


METHODS
Review of clinical history, laboratory findings, histology of episcleral and cervical lymph node biopsies, and follow-up.


RESULTS
A 20-year-old female presented with a 5-month history of redness and pain in her left eye, with associated symptoms of dyspnea, malaise, and fever. The patient was found to have multifocal nodular episcleritis and scleritis that was not responsive to topical steroids or systemic nonsteroidal anti-inflammatory treatment. Laboratory tests subsequently revealed evidence of systemic inflammation, and radiologic studies showed extensive mediastinal and cervical adenopathy. A cervical lymph node biopsy showed Reed-Sternberg cells and a chronic lymphocytic infiltrate consistent with nodular sclerosing Hodgkin's lymphoma. Histopathologic analysis of an episcleral nodule revealed a necrotizing granuloma with vasculitis. Systemic chemotherapy was instituted for the Hodgkin's disease; this therapy abolished the nodular scleritis.


CONCLUSIONS
This case raises the possibility of concurrent undiagnosed systemic vasculitis with only an ocular manifestation with Hodgkin's lymphoma, either as a coincidence or as a paraneoplastic syndrome. Moreover, it emphasizes the important role of tissue biopsy in establishing diagnosis and directing treatment.
Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
Manoj M
MM
Thakker
Victor L
VL
Perez
Alexandre
A
Moulin
Sandra L
SL
Cremers
C Stephen
CS
Foster
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D005134:Eye Neoplasms / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006689:Hodgkin Disease / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D015423:Scleritis / Q000188:drug therapy / Q000473:pathology*
D000970:Antineoplastic Agents