Incomitant strabismus as a form of presentation of neurolymphymatosis

Purpose: To report a case of Neurolymphomatosis to raise awareness of this condition. Neurolymphomatosis (NL) is the invasion of cranial nerves or roots by malignant cells from a non‐Hodgkin lymphoma (NHL). Methods: A 74 years old female, with known large B cell lymphoma treated 2 years prior with R‐CHOP chemotherapy, consulted our department for diplopia and blurred vision in left eye (OS). The clinical exploration evidenced a decrease of visual acuity (VA) on OS associated with hyporeactive pupil and signs of granulomatous panuveitis with inferior subretinal infiltrates. On her right eye (OD), she had a limitation of adduction, supraduction and underduction. A magnetic resonance imaging (MRI) was performed, which found a mandibular mass. Its pathological study confirmed a recurrence of haematological disease and a new line of treatment with chemotherapy was established. Results: 2 weeks later, resolution of the strabismus and reabsorption of the retinal infiltrates were observed. The final VA of the patient was 0.8. Conclusions: Contrast MRI is the most specific and sensitive non‐invasive imaging technique, as the path of the infiltrated nerves will capture gadolinium. PET‐CT with FDG‐18 can help locate possible biopsy areas. The Gold Standard diagnostic technique is the biopsy of the affected nerves, but can only be performed in 50% of cases. Clinical information from the ophthalmological examination can be a support to guide the diagnosis. References. 1. Baehring JM, Batchelor TT. Diagnosis and management on neurolymphomatosis. Cancer J. 2012;18(5):463–8. 2. Sahin H, Mete A, Pehlivan M. Neurolynphomatosis in non‐Hodgkin lymphoma with cranial multineuritis. Medicine. 2018;97:15.