A 42-year-old man came to the emergency department with a bilateral and progressive decrease in vision of several weeks' duration.
His personal history included chronic hepatopathy due to virus C and an autoimmune Evans syndrome (autoimmune thrombocytopenic purpura with anaemia) of long evolution, which had required splenectomy 20 years earlier. Maintenance treatment was 30 mg oral prednisone every other day.
On ophthalmological examination, best corrected visual acuity in OD was 0.3 and in OS 0.2. Biomicroscopically, there was a posterior subcapsular cataract 1+ in OD and 2+ in OS. Funduscopy revealed multiple areas of neurosensory and retinal pigment epithelium detachment (RPE) in the posterior pole of both eyes, as well as small, rounded, discrete and sparse whitish lesions in the equatorial retina of both eyes. In addition, other peripheral pigmented cicatricial lesions were present in OS. Optical coherence tomography (OCT) revealed detachments involving the macula in both eyes.

Angiofluoresceingraphy was indicated, but was not performed because 2 days later the patient was admitted with a high fever, laterocervical lymphadenopathies and persistent diarrhoea. He was treated empirically with cefotaxime and corticotherapy, but evolved unfavourably, presenting respiratory difficulty with progressive deterioration of his general condition. CT scan showed a large mediastinal enlargement, and biopsy of the cervical lymph nodes revealed a diffuse large B-cell lymphoma with CD20+ marker. With the diagnosis of stage II E diffuse large B-cell non-Hodgkin's lymphoma, he received 6 cycles of CHOP chemotherapy and rituximab. Throughout the chemotherapy treatment (especially from the 3rd cycle onwards), the patient already experienced a clear visual improvement, with progressive reapplication of all the foci of sensory detachment and RPE, leaving retinochoroidal scars with pigment redistribution. Six months after chemotherapy, complete remission of the lymphoma was confirmed by CT and scintigraphy, and the retinas were applied and the old exudative lesions had a cicatricial and inactive appearance. OCT confirmed resolution of the detachments. VA was 0.7 in OD and 0.6 in OS and the patient is awaiting cataract surgery.