Observation :
A 46-year-old male presented at our formation with a 3-month history of
ocular symptoms. He complained of feeling of sandy sensation in the
eyes, ocular redness then swelling of the lower eyelid with general
symptoms. This symptomatology was not improved by local treatments.
At physical examination, visual acuity was 10/10; a light reflex
retained a right proptosis and swelling of the right lower eyelid with
significant chemosis. The fundus was normal.
Laboratory results showed normal blood count. Serum tests revealed that
LDH was 535 UI/L, β2-microglobulin: 2.02 mg/L, with normal both renal
and hepatic functions.
Histopathology of the conjunctival biopsy revealed diffuse,
heterogeneous lymphoid proliferation with arborizing epithelioid
venules. Immunohistochemistry showed that the neoplastic cells express
LCA, CD3, CD43 and CD45, and negative expression for CD20, CD21, CD23,
cytokeratin, myogenin and vimentin (figure 2).
Chest, Abdomen and Pelvis CT and brain CT were normal. The bone marrow
biopsy showed no lymphoma infiltration. To sum up, our patient had a
primary conjunctival peripheral T-cell lymphoma.
The patient successfully received four courses of chemotherapy with
cyclophosphamide, doxorubicin hydrochloride, vincristine, and
prednisone.
Fifteen days after the fourth course, the patient presented with left
facial paralysis and monoplegia of the left arm and right leg. Physical
examination revealed glove and stocking hypesthesia and absence of deep
tendon reflexes. The plantar reflex was normal. The brain CT (with
contrast) was normal. A lumbar puncture was performed. The cerebrospinal
fluid protein (CSF) concentration was increased at 3,29g/l. The cytology
CSF confirmed the diagnosis of leptomeningeal lymphoma. The patient
received a high-dose intravenous methotrexate with intrathecal
chemotherapy. At the 30th day of follow-up, the patient died because of
a septic shock.