Bilateral Intraocular Involvement of Recurrent Mantle Cell Lymphoma with Remission of Pseudo-Uveitis and Secondary Glaucoma After Switching Treatment to Ibrutinib: A Case Report

We describe a case of bilateral pseudo-uveitis and secondary glaucoma associated with recurrent mantle cell lymphoma (MCL) that was successfully treated with ibrutinib.
Retrospective case report.
A 75-year-old man presented with uveitis masquerade syndrome while undergoing treatment for MCL with rituximab–bendamustine. Initial ophthalmologic examination revealed pseudohypopyon, iris thickening, and considerable vitreous opacity of both eyes. Evaluation via anterior segment optical coherence tomography revealed iris thickening in both eyes. His best-corrected visual acuities were reduced to 20/28 and 20/2000 on the right eye (OD) and left eye (OS), respectively, and his intraocular pressure (IOP) was elevated at 40 (OD) and 52 (OS) mmHg. The patient had findings suggestive of recurrent MCL, such as skin lesions, hyponatremia, elevated blood lactase dehydrogenase, and the results of the skin biopsy were consistent with the pathological diagnosis of MCL in the bone marrow biopsy that had already been performed. He was diagnosed with MCL recurrence and treated by switching to ibrutinib, a Bruton’s tyrosine kinase inhibitor. After 1 week of treatment, all anterior ocular and vitreous lesions disappeared. Moreover, the skin lesions also disappeared, and the blood sample findings improved. On day 11 of treatment, BCVA improved to 20/20 in both eyes and IOP decreased to 8 (OD) and 11 (OS) mmHg. During the study course, CD5 and CD20 positive cells were identified in the anterior chamber of the eyes via flow cytometry, which was consistent with the pathological findings of biopsies.
Ibrutinib may improve recurrent MCL intraocular lesions.

本研究报告1例继发于复发性套细胞淋巴瘤（mantle cell lymphoma, MCL）的双侧假性葡萄膜炎及继发性青光眼，该患者经依鲁替尼（ibrutinib）治疗后病情获得成功控制。
本研究为回顾性病例报告。
1例75岁男性患者在接受利妥昔单抗-苯达莫司汀方案治疗套细胞淋巴瘤期间，出现伪装性葡萄膜炎（uveitis masquerade syndrome）。初次眼科检查显示，患者双眼均出现假性前房积脓（pseudohypopyon）、虹膜增厚及显著玻璃体混浊（vitreous opacity）。眼前节光学相干断层扫描（anterior segment optical coherence tomography）检查证实双眼虹膜增厚。患者右眼（OD）、左眼（OS）的最佳矫正视力（best-corrected visual acuity, BCVA）分别降至20/28和20/2000，眼压（intraocular pressure, IOP）分别升高至40（OD）和52 mmHg。患者存在多项提示套细胞淋巴瘤复发的异常表现：包括皮肤病变、低钠血症、血乳酸脱氢酶水平升高，且既往骨髓活检及本次皮肤活检的病理结果均符合套细胞淋巴瘤的诊断。患者确诊为套细胞淋巴瘤复发后，更换为布鲁顿酪氨酸激酶抑制剂（Bruton’s tyrosine kinase inhibitor）依鲁替尼进行治疗。治疗1周后，患者眼前节及玻璃体病变完全消失，皮肤病变也得以消退，血液实验室指标改善。治疗第11天，双眼最佳矫正视力均恢复至20/20，眼压分别降至8（OD）和11 mmHg。研究期间，通过流式细胞术（flow cytometry）在患者眼前房液中检测到CD5及CD20阳性细胞，与活检病理结果相符。
依鲁替尼可改善复发性套细胞淋巴瘤的眼内病变。