• Hui-Chuan Kau, Cheng-Jen Wang, and Chieh-Chih Tsai.
• Department of Ophthalmology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
• Medicine (Baltimore). 2022 Jul 22; 101 (29): e29637e29637.

RationalePrimary vitreoretinal lymphoma is a great masquerader and provides a diagnostic challenge.It is most frequently misdiagnosed as a chronic uveitis. Steroid treatment for presumed uveitis can interfere with the correct diagnosis of vitreoretinal lymphoma. Herein, we present a case of primary vitreoretinal lymphoma in which the correct diagnosis was delayed by short-term steroids until 2 years later.Patient ConcernsA 45-year-old woman presented with floaters and blurred vision in her right eye for 3 months. An ocular examination revealed dense vitreous cells. Three months later, she developed headache and suicidal ideation after taking a 3-week medication of oral steroid medication from another eye clinic. Brain magnetic resonance imaging revealed a tumor involving the corpus callosum and periventricular region.InterventionsVitreous biopsy and repeated brain biopsies were carried out for the patient.DiagnosisA brain biopsy was performed for the first time, and a vitreous biopsy was performed when steroid medication was suspended for 20 and 41 days, respectively. Both biopsies were negative for the presence of malignant cells. Follow-up magnetic resonance imaging revealed complete remission of the brain tumor. Two years later, the tumor recurred in the optic chiasm. Diffuse large B-cell lymphoma was confirmed by a second brain biopsy.OutcomeThe patient had complete tumor remission after receiving brain radiation therapy and chemotherapy.LessonsVitreoretinal lymphoma is difficult to diagnose owing to its rarity, masquerading presentation, and steroid-induced apoptosis of lymphoma cells. Physicians should consider vitreoretinal lymphoma as an important differential diagnosis in patients presenting with chronic uveitis and use steroids cautiously before making a definitive diagnosis.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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