Answer to previous #DiagnosticDilemma
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A 48-year-old man with deteriorating vision over the previous 3 weeks; he had no pain and no other eye symptoms.

In his medical history, he had been diagnosed with advanced stage, aggressive B-cell lymphoma—with no indication of CNS involvement: his cerebrospinal fluid had shown no cancer cells. He had been treated with systemic chemotherapy, with rituximab and intrathecal methotrexate prophylaxis for six cycles over a 110-day period, resulting in a complete remission; the last dose of his treatment was given 88 days before the onset of his vision problems.

It is concerned that he might have ocular metastasis—given the recent history of B-cell lymphoma. The patient was again treated with rituximab and high-dose methotrexate. The pseudohypopyon had completely resolved in the right eye and was much reduced in the left; his intraocular pressures returned to within normal range using topical therapy.
A hypopyon—also known as sterile pus—is produced because of toxins, which are usually produced by pathogens, causing the collection of leucocytes in the anterior chamber of the eye. It can occur with a corneal ulcer, Behçet's disease, endophthalmitis, and an adverse reaction to some drugs—including rifabutin.

Pseudohypopyons can be caused by metastatic cells: they have been reported with leukemias, lymphomas, and retinoblastomas. Patients with n, but cannot be repeated often enough, eye problems should prompt a thorough history and an investigation for primary cancer or for referral for further treatment in a patient with known malignancy.

Diagnostic Dilemma:

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