Summary

A 50-year-old man with a past history of autoimmune disease presented with posterior uveitis followed by relapsing remitting mononeuritis multiplex and hypersensitivity to pain despite continuation of high doses of steroids and the introduction of other immunosuppressive agents. Extensive initial investigations, including high resolution chest CT, were negative apart from a raised serum angiotensin-converting enzyme (ACE). The patient was initially thought to have sarcoidosis and treated with high dose prednisolone, but developed a series of cranial nerve palsies on treatment, some of which improved without any change in treatment. Vasculitis was suspected and steroid sparing agents introduced. Ten months after the first visual symptoms, constitutional symptoms became a feature of the illness and new cranial nerve palsy developed quite suddenly after a pulse of steroid, prompting further review. Non-Hodgkin’s lymphoma was finally diagnosed following vitrectomy.