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.