SHM Converge Scientific Abstract ePoster Gallery-Eye Metastasis in Lung Adenocarcinoma, Masquerading as Recurrent Uveitis

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A 59-year-old man with a 30 pack-year smoking history presented with 2 months of left eye vision loss and floaters, initially treated as recurrent uveitis but refractory to steroids and multiple intravitreal antibiotics/antifungals. Eye exam showed severe left visual impairment, nonreactive pupil, hazy vitreous, and partial retinal detachment; ultrasound suggested exudative material beneath the detachment. Infectious and inflammatory workup was negative.<br /><br />Because of persistent symptoms, a chest x-ray was obtained and revealed a 4.1 cm lingular lung mass. Further imaging with MRI of the brain and orbits showed left ocular enhancement plus widespread metastatic disease, including hemorrhagic brain lesions, lymphadenopathy, pulmonary nodules, rib lesions, and adrenal nodules. Lung biopsy confirmed metastatic invasive mucinous adenocarcinoma of the lung with PDL1 expression (50%), ERBB2 exon 20 insertion, and TP53 mutation.<br /><br />The patient was started on systemic therapy with pembrolizumab, pemetrexed, and carboplatin, then transitioned to pembrolizumab maintenance. The case highlights that ocular metastasis can masquerade as uveitis, and in this patient the eye symptoms were the only initial complaint despite advanced stage IV lung cancer.<br /><br />The report emphasizes the importance of considering malignancy in refractory or atypical uveitis, especially in patients with limited preventive care or smoking history. It also underscores the need for lung cancer screening and tobacco counseling in high-risk individuals, since lung cancer is commonly diagnosed late and has poor survival when metastatic.

Asset Subtitle

Emily G. Sherry

Meta Tag

Author List Emily G. Sherry, Frank Scribbick, Hayley Favre

Category Clinical Vignettes

Concept Uveitis

Concept Intraocular Malignancy

Concept Lung Adenocarcinoma

Concept Masquerade Syndrome

Concept Metastatic Disease

Distinguished Non-Finalist

Presenter Organization UT Health San Antonio

Presenting Author Emily G. Sherry

Track Adult

Keywords

ocular metastasis

uveitis

lung adenocarcinoma

metastatic disease

vision loss

smoking history

retinal detachment

brain metastases

PDL1 expression

ERBB2 mutation

Uveitis

Intraocular Malignancy

Lung Adenocarcinoma

Masquerade Syndrome

Metastatic Disease