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BMJ Case Reports 2017; doi:10.1136/bcr-2017-219946
  • Rare disease
  • CASE REPORT

Gamma–delta T-cell lymphoma of skin, eye and brain presenting with visual loss

  1. Sarah Coupland3
  1. 1Manchester Royal Eye Hospital, Manchester, UK
  2. 2Lymphoma Medical & Clinical Oncology Service, Christie NHS Foundation Trust, Manchester, Manchester, UK
  3. 3Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, Merseyside, UK
  1. Correspondence to Professor Nicholas Jones, nicholas.jones{at}cmft.nhs.uk
  • Accepted 21 May 2017
  • Published 15 June 2017

Summary

A young man presented with rapid, predominantly right-sided visual loss with a background of multifocal skin lesions. Visual acuity was right hand movements, left 6/5 Snellen, deteriorating to 6/38. He showed panuveitis with bilateral multifocal retinal infiltrates and retinal vasculitis. Multifocal brain lesions were identified. Biopsy of both skin and vitreous showed atypical lymphocytes, and immunohistochemistry confirmed T-cell lymphoma of gamma–delta subtype. Management with the CODOX-M/IVAC polychemotherapy regimen achieved rapid response including resolution of intraocular changes and substantial improvement of visual acuity to right 6/7.5, left 6/6. However, he relapsed before planned stem cell transplantation. Salvage with the gemcitabine/dexamethasone/cisplatin regimen, although temporarily effective, was followed by further relapse including widespread brain involvement, and he succumbed 10 months after presentation.

Footnotes

  • Contributors All authors were involved in the clinical care of the patient. NJ conceived the case report. The manuscript was drafted by NJ and contributed to by all authors. Data on histology and cytology was provided by LI and SC. All authors performed a literature search and contributed references. All authors read and corrected the draft manuscript. NJ sourced the clinical images. LI sourced the cytology images.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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