Bilateral uveitis with hypopyon as a presenting symptom of metastatic peritoneal carcinomatosis

PURPOSE. To report the association between bilateral uveitis with hypopyon and metastatic peritoneal carcinomatosis. METHODS. A 76-year-old woman presented bilateral diffuse uveitis with hypopyon. She was in good health. She reported breast cancer history 20 years before with no recurrence of tumor at periodic examinations. RESULTS. The patient had visual acuity of count fingers in both eyes, hypopyon, and vitritis with no chorioretinal lesions. After 1 week of steroids, visual acuity and intraocular inflammation improved significantly. Given the late age at uveitis onset, clinical picture of uveitis, and breast cancer history, we suspected associated malignancy. Total body computed tomography revealed peritoneal carcinomatosis, which was removed 1 month later. After 12 months, visual acuity was 0.8 bilaterally and bilateral uveitis resolved completely. CONCLUSIONS. Excluding a masquerade syndrome and a paraneoplastic syndrome on the basis of clinical features, uveitis represents an immune response to the concurrent tumor. The good response to steroid therapy is in accordance with this hypothesis. This is the first case of uveitis with hypopyon as presenting symptom of a metastatic peritoneal carcinomatosis developing 20 years after the removal of primitive breast cancer. (Eur J Ophthalmol 2010; 20: 948-51)