Hematologic malignancies occasionally cause serous retinal detachment (SRD); however, its pathogenesis remains unclear. Here we present the imaging characteristics of metastatic choroidal lymphoma masquerading as Vogt-Koyanagi-Harada (VKH) disease. A 45-year-old Japanese woman was referred to our clinic because of bilateral SRD with blurred vision. Fluorescein angiography revealed multiple pinpoint leakage followed by pooling OU. Enhanced depth imaging optical coherence tomography showed marked choroidal thickening OU. Laser speckle flowgraphy detected choroidal circulation impairment OU. Although these results totally agreed with the inflammatory manifestations of acute VKH disease, indocyanine green angiography demonstrated various sizes of sharply marginated hypofluorescent lesions that seemed atypical for the finding of VKH disease, i.e., vaguely marginated hypofluorescent small dots. Cerebrospinal fluid pleocytosis was not detected. Blood tests revealed leukocytosis together with elevation of lactate dehydrogenase and soluble interleukin-2 receptor levels. Corticosteroid pulse therapy did not improve any ocular findings. Bone marrow biopsy was then performed, leading to a definite diagnosis of diffuse large B-cell lymphoma. After starting systemic chemotherapy, both SRD and choroidal thickening resolved rapidly with visual recovery. However, choroidal hypoperfusion persisted, which contrasted distinctly with the inflammatory pattern of VKH disease, i.e., the restoration of choroidal blood flow in parallel with normalization of choroidal thickness. Our detailed multimodal observations highlighted the differential imaging features of choroidal lymphoma despite close resemblance to VKH disease especially at the initial stage. Impaired circulation in the thickened choroid marked the pseudo-inflammatory pathogenesis of SRD due to choroidal involvement with neoplastic, but not inflammatory cells.

中文翻译：

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脉络膜淋巴瘤的伪炎性表现，类似于Vogt-Koyanagi-Harada病：基于多模态成像的病例报告

血液系统恶性肿瘤偶尔会导致浆液性视网膜脱离（SRD）；然而，其发病机理仍不清楚。在这里，我们介绍了伪装成Vogt-Koyanagi-Harada（VKH）疾病的转移性脉络膜淋巴瘤的影像学特征。一名45岁的日本女性因双侧SRD视力模糊而被转诊至我们的诊所。荧光素血管造影显示多处针尖漏出，随后合并OU。增强深度成像光学相干断层扫描显示明显的脉络膜增厚OU。激光散斑造影检测到脉络膜循环障碍OU。尽管这些结果与急性VKH疾病的炎症表现完全吻合，但吲哚菁绿血管造影显示出各种大小的边缘明显的低荧光性病变，这对于发现VKH疾病似乎是非典型的。边缘模糊的次荧光小点。未检测到脑脊液的胞吞作用。验血显示白细胞增多，乳酸脱氢酶升高和可溶性白介素2受体水平升高。皮质类固醇脉冲治疗并不能改善任何眼部发现。然后进行骨髓活检，明确诊断为弥漫性大B细胞淋巴瘤。开始全身化疗后，SRD和脉络膜增厚均迅速消失，并伴有视觉恢复。然而，脉络膜灌注不足持续存在，这与VKH疾病的炎症模式形成鲜明对比，即，脉络膜血流的恢复与脉络膜厚度的正常化并行。尽管与VKH疾病非常相似，但特别是在初期，我们详细的多模式观察结果强调了脉络膜淋巴瘤的差异成像特征。脉络膜增厚中的循环障碍标志着SRD的假性炎症发病机理，这是由于脉络膜累及了肿瘤细胞，而非炎症细胞。