Report of a case of nasal-type extranodal NK/T-cell lymphoma with ciliary body involvement and literature review of interleukin-10 and interleukin-6 in intraocular T-cell lymphoma.

PURPOSE: To present a presumed case of NK/T-cell lymphoma with ciliary body involvement, emphasizing key clinical findings and diagnostic testing that facilitated differentiation from anterior uveitis.

METHODS

Retrospective case report and review of the literature.

RESULTS

A 47-year-old man with a history of nasal-type extranodal NK/T-cell lymphoma (ENKL) presented with cloudy vision in the left eye and was initially diagnosed with anterior uveitis. Work-up initially included aqueous interleukin-10 (IL-10) and interleukin-6 (IL-6) ratio determination, and later B-scan and ultrasound biomicroscopy (UBM). The IL-10/IL-6 ratio was less than 1, but ultrasound imaging revealed peripheral subretinal fluid and ciliary body thickening. The patient underwent five cycles of intravitreal methotrexate for presumed uveal lymphoma involving the ciliary body with pseudo-keratic precipitates before a nasal biopsy confirmed recurrent ENKL. A review of the literature regarding IL-10/IL-6 ratios showed that 71 % of published cases of intraocular T-cell lymphoma had ratios less than 1.

CONCLUSION

ENKL, nasal type, is an aggressive and uncommon disease, and its ocular involvement, though infrequent, can resemble anterior uveitis. The IL-10/IL-6 ratio is of limited value in the diagnosis of T-cell lymphoma affecting intraocular structures. This case highlights the critical role of UBM in identifying ciliary body involvement of intraocular malignancies.