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TitreBilateral diffuse uveal melanocytic proliferation (BDUMP) revealing lung adenocarcinoma
ButTo report BDUMP as the presenting sign of an occult lung adenocarcinoma and highlight the contribution of multimodal ocular imaging and plasma exchange.
MéthodesA 67-year-old man presented with a 3-week history of painless bilateral visual loss. Complete ophthalmic examination, OCT, fluorescein angiography and B-scan ultrasonography were performed. Systemic staging included contrast-enhanced CT, brain MRI, PET-CT and nodal sampling.
RésultatsRight eye (RE) visual acuity was 16/20 and counting fingers in the left eye (LE). Bilateral pigmented vitreous cells, multifocal uveal melanocytic lesions, serous retinal detachments (SRDs) and outer-retinal irregularities were observed, as well as an iris naevus-like lesion in the RE. Fluorescein angiography showed typical reticular early hyperfluorescent orange-red subretinal patches with retinal pigment epithelium atrophy. Urgent systemic work-up disclosed a pleura-contacting right lower-lobe mass with mediastinal nodal involvement; pathology confirmed poorly differentiated lung adenocarcinoma. After five plasma-exchange sessions, subretinal fluid regressed in LE and visual acuity improved to 2/20, although RE visual acuity deteriorated due to the migration of SRDs toward the subfoveal region.
ConclusionBDUMP may be the first manifestation of an otherwise occult malignancy and should prompt urgent systemic investigation. Multimodal imaging is pivotal for distinguishing this paraneoplastic syndrome from uveal melanoma and other causes of bilateral serous detachment. While outcomes remain variable, early plasma exchange may be the only opportunity for anatomical and functional improvement in selected cases, alongside treatment of the underlying cancer.
Conflit d'intérêtNon
Auteurs 1
NomEL KORTOBI
InitialesS
InstitutCUSL
VilleBrussels
Auteurs 2
NomBUGHIN
InitialesA
InstitutCUSL
VilleBrussels
Auteurs 3
NomGUESSOUS
InitialesY
InstitutCUSL
VilleBrussels
Auteurs 4
NomBARTOSZEK
InitialesP
InstitutCUSL
VilleBrussels
Auteurs 5
NomKOZYREFF
InitialesA
InstitutCUSL
VilleBrussels
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