This 73YO man presented with subacute vision loss and these retinal findings. There were variable yellow-white, mostly confluent, lumpy subretinal infiltrates throughout the right posterior pole. The left fundus was normal.
He had a remote history of bladder cancer, which was in remission. He had recently completed chemotherapy for non-Hodgkin lymphoma, including a left retroperitoneal biopsy confirming a diffuse large B-cell lymphoma. We felt the findings in his right eye were consistent with metastatic lymphoma to the choroid.
Systemic chemotherapy supplemented with weekly intravitreal methotrexate was started. About 6 weeks later, vision remained at counting fingers, but there was a dramatic, complete clinical resolution of the tumor.
