PMC9897933_01
General examination at the first visit.. (A) Histopathological findings of inguinal lymph node biopsy showing multiple lymphoid follicles and vascular invasion into the follicles (arrowheads). Lymphocytes are arranged in concentric circles surrounding the mantle layer outside the follicle, suggesting multicentric Castleman disease. (B) Thoracic x-ray photograph showing bilateral hilar lymphadenopathy and pleural effusion, infiltrative shadows, and cardiomegaly. (C) Chest computed tomography showing multiple lymph node enlargements in the mediastinum and hilar regions.
cureus-0015-00000033368-i01.jpg
PMC9897933_01_cureus-0015-00000033368-i01.jpg
FIG1
Inguinal lymph node biopsy showed no findings suggestive of an aggressive hematopoietic tumor but findings consistent with CD (Figure 1A). Chest x-ray showed bilateral pleural effusions and cardiomegaly (Figure 1B). A computed tomography scan of the chest also revealed ground-glass opacity and multiple lymphadenopathies (Figure 1C).
Ocular manifestation before treatment.. (A, B) Fundus photograph shows multiple bilateral gray-yellow patches (Elschnig spots) and sprinter hemorrhage in the optic disc (arrow). Bilateral Narrowed arterioles and vascular tortuosity were observed. (C, D) Fluorescein angiography shows bilateral punctate hyperfluorescence, and staining was observed in line with the location of the Elschnig spot. (E, F) Indocyanine green angiography shows bilateral extensive mottled choroidal staining (*) and partial bright staining of choroidal vessels (arrowheads).
cureus-0015-00000033368-i02.jpg
PMC9897933_01_cureus-0015-00000033368-i02.jpg
FIG2
Fundus examination revealed multiple Elschnig spots (gray-yellow patches) at the level of the retinal pigment epithelium (RPE), and a sprinter hemorrhage was located around the optic disc (Figures 2A, 2B). Fluorescein angiography (FA) showed multiple punctate hyperfluorescence and staining in line with the location of the Elschnig spot (Figures 2C, 2D). According to indocyanine green angiography (IA), scattered tissue staining and bright choroidal vessel staining, and increased choroidal vascular permeability were present (Figures 2E, 2F).
Optical coherence tomography findings before and after treatment.. (A), (B) Optical coherence tomography showing exudative retinal detachment involving the fovea. Bilateral fibrin formation was observed in the subretinal space (arrowheads). (C), (D) Recovery of the retinal and choroidal structures. An increase in choroidal thickness was observed in the acute phase and recovered with treatment.
cureus-0015-00000033368-i03.jpg
PMC9897933_01_cureus-0015-00000033368-i03.jpg
FIG3
Swept-source optical coherence tomography (SS-OCT) examination showed intraretinal fluid in the right eye, bilateral serous retinal detachment (SRD), and exudates on RPE corresponding to Elschnig spots (Figures 3A, 3B). His SRD and retinal edema gradually resolved within a matter of two weeks (Figures 3C, 3D), and the fundus appearance normalized (Figures 4A, 4B). At three months after the start of treatment, SRD and hyperreflective material under the retinal pigment epithelium disappeared in both eyes (Figures 3C, 3D).
Ocular manifestation after treatment.. (A), (B) Fundus photograph revealed that the bilateral Elschnig spots and hemorrhage disappeared. (C), (D) Fluorescein angiography shows scattered window defects and loss of staining. (E), (F) Indocyanine green angiography shows that choroidopathy with increased vascular permeability disappeared, resulting in normal contrast findings.
cureus-0015-00000033368-i04.jpg
PMC9897933_01_cureus-0015-00000033368-i04.jpg
FIG4
His SRD and retinal edema gradually resolved within a matter of two weeks (Figures 3C, 3D), and the fundus appearance normalized (Figures 4A, 4B). FA examination showed that the filling defect remained partial but that both hyperfluorescence and blocked fluorescence resolved (Figures 4C, 4D). Choroidal vascular hyperpermeability was normalized (Figures 4E, 4F).