Panophthalmitis Masquerading as Ocular Melanoma-an Eye Opener

Introduction: We report a clinicopathological correlation of a 45 year-old female who manifested as melanoma clinically and radiologically but turned out to have acute panopthalmitis on histopathology examination. We feel that there is significant clinical implication in sharing the knowledge of this clinico-pathological correlation.

Case Presentation: A 45 year- old female presented with complaints of sudden painful diminution of vision in left eye for five days. Examination revealed proptosis of left eye with neovascularization of iris, seclusiopupillae, and fundus details could not be visualized. Computerized Tomogram (CT) examination, 99m TC mibi whole body scan and Single-photon emission computed tomography (SPECT CT) were done. SPECT CT showed focal area of increased tracer uptake in anterior and superolateral aspect of choroid in left eye. Avid mibi tracer uptake in choroid of left eye suggested a high possibility of ocular tumor with involvement of retrobulbar portion of left optic nerve. Histopathological examination revealed panophthalmitis with dense neovascularization of the choroid and ciliary body. No tumor cells or necrosis were evident in the sections studied. Sections from optic nerve showed extensive perineurialedema. Immunohistochemistry with Melan A, S-100 and HMB-45 were performed on multiple sections and were negative, thus excluding the possibility of melanoma.

Conclusion: Painful blind eye is a major therapeutic dilemma for ophthalmologist and findings such as avid mibi tracer uptake in the choroid of left eye suggested a high possibility of ocular tumor. We wish to emphasise that inflammatory pathologies of the eye can masquerade as malignancies and to highlight the limitations of the state.