| Description: |
Case report - Introduction Rheumatoid arthritis (RA) is a life-long systemic autoimmune inflammatory disease associated with numerous co-morbidities, one of which includes the increased risk of developing lymphoproliferative disorders. RA patients have been found to be at increased risk of developing lymphoma, with non-Hodgkin’s lymphomas (NHL), especially B-cell lymphoma, being the most common. Rituximab is a biologic disease modifying anti-rheumatic drug (bDMARD) that inhibits b cells used in oncology and rheumatology. In this case report, we present a middle-aged female with RA who developed B-cell lymphoma affecting her right eye after a reduction in the frequency of her rituximab therapy. Case report - Case description A 43-year-old female was diagnosed with RA at age 27 and experienced dry eyes and corneal ulcers during her disease. Her RA was well controlled on adalimumab. She presented to clinic with right-sided eyelid and lacrimal gland swelling which had progressed over 4 months, with reduced eye motility and visual acuity (6/24). A CT scan revealed a mass lesion in the superolateral quadrant of the orbit involving the lacrimal gland. Histology from an incisional biopsy concluded that the diagnosis was “chronic idiopathic orbital inflammation”. The immunohistochemical report revealed a mixture of B- and T-cell populations, with no definite light chain restriction. The test for serum IgG4 was negative, ruling-out IgG4 disease. She was subsequently admitted to the hospital and received three 250mg infusions of methylprednisolone, followed by 6-monthly rituximab infusions. Following methylprednisolone therapy, her vision had improved 6/6 on the right, and 6/5 on the left. She went on to respond to the rituximab treatment, and the orbital mass shrank as her vision returned to baseline. After 7 years on 6-monthly rituximab cycles, her RA remained stable. Her immunoglobulins were normal, and she requested to be transferred to a local hospital for convenience of travel. At this centre, she received ... |