University of Iowa Health Care

Ophthalmology and Visual Sciences

Masquerade Syndrome (slit lamp only)

This 60-year-old patient was diagnosed with glaucoma 12 years prior to being seen. He had a history of chronic uveitis in the right eye. In 2012 he was diagnosed with sarcoid based on a positive lung biopsy. In July 2012 he was seen in our glaucoma clinic with an intraocular pressure of 40 mmHg, 360° of peripheral anterior synechia and a cataract. He underwent cataract extraction with intraocular lens and Ahmed seton. Twelve weeks after his surgery he had a hypopyon with an atypical appearance. A tap and inject was performed and no growth was found. Parallel to this he developed epididymitis which worsened on oral steroids. He was also losing weight on oral steroids. A paracentesis demonstrated a high grade B-cell lymphoma and a PET scan showed lymphoma in the retroperitoneal abdominal wall and testes. He had a right orchiectomy which was positive for B-cell lymphoma.