Reply to: differential diagnosis of pseudohypopyon and discussion of extranodal natural killer/T-cell lymphoma presenting as hypopyon panuveitis

Abstract

Extranodal natural killer/T-cell lymphoma rarely presents as intraocular masquerade syndrome. We thank Dr. Evereklioglu for bringing up the importance of a thorough ocular examination, differential diagnosis, and consideration of the characteristics of ocular masquerade syndrome.

A novel terminologic “naming-meshing” system using anterior chamber sedimentation for early diagnosis and prompt treatment of ocular or systemic diseases: is it hypopyon or pseudohypopyon?

“…Post-vitrectomy, management of retinal detachment 6. Color (hue) [1,[4][5][6][15][16][17][18][19][20][21][22][23][24][25][26] Hypopyon White (grayish-white)…”

“…Location(s)-number [14,28,[38][39][40][41][42][43] Hypopyon 12. Purulence [1,[4][5][6]19,[21][22][23][24] Inflammatory hypopyon Sediment consisting of exudates, proteins, necrotic tissue debris, byproducts, and PMNLs with or without microorganisms HLA-B27-related AAU, OBD, endogenous metastatic endophthalmitis, after IVTA injection Suppurative hypopyon A purulent hypopyon causing pus formation from infective etiologies Bacterial, fungal, or viral severe corneal infections Non-suppurative hypopyon A non-purulent hypopyon without pus formation, but still an inflammatory hypopyon OBD, herpetic uveitis, uveitis after laser iridotomy or PRP…”

“…Moreover, "darkly pigmented hypopyon" after tuberculosis [17] or "black-colored pseudohypopyon" can be seen in some primary intraocular or metastatic necrotic uveal melanomas [18] whereas progressively darkening "pigmented hypopyon" from tan to black in color is observed in Listeria monocytogenes-and Serratia marcescens-induced endogenous endophthalmitis as a result of melanin pigment dispersion into the anterior chamber from necrotic iris, leading to the hypopyon's dark hue [19][20][21] . Rarely, spontaneous hyphema may result in a "blood-tinged", "blood-streaked", "blood-stained", or "hemorrhagic" pseudohypopyon as a presenting feature of leukemia, lymphoma or AIDS [8][9][22][23][24][25] . Herpetic keratouveitis as a result of severe Herpes Simplex virus or Varicella Zoster virus may also cause anterior chamber hypopyon with or without hyphemia and endothelium folds, regardless of the presence of polymicrobial superinfection, realizing a pattern called "candy-cane hypopyon" [24] .…”