Masquerade syndromes are a group of ocular disorders that present as intraocular inflammatory processes but are in fact non-inflammatory diseases. The term “masquerade syndrome” was first used in ophthalmology by Theodore in 1967 to describe a conjunctival carcinoma that presented as chronic conjunctivitis. Predominantly used for referring to neoplastic causes, They can sometimes be due to non-neoplastic causes. Incorrect diagnosis of the masquerade syndromes (MS) may have severe consequences. The correct diagnosis and treatment of MS is fundamental for the prognosis and patient's life. This study analyzed clinical manifestations, diagnostic tests.
In this retrospective study of case series with five patients diagnosed of mascarade syndrome attended at the Ophthalmology Department of Federal University of Sao Paulo from February of 2013 to July of 2017. The patients were diagnosed based on clinical evaluation, results laboratory, photographic, ocular ultrasound and result of the biopsy (3 patients).
Two patients had ocular malignancy (necrotizing scleritis secondary to squamous cell carcinoma and intraocular metastatic carcinoma of unknown primary), One patient had lymphoid hyperplasia in the upper palpebra, Two patients with granuloma of the ciliary body caused by Mycobacterium tuberculosis initially simulated amelanotic melanoma. Patients with neoplastic MS were older than those with non-neoplastic MS (average age 62 vs 25 years). For patients with neoplastic masquerade syndromes, the average length of time between the onset of symptoms and definitive diagnosis was 8 months (Table 1). The manifestation of malignant MS was necrotizing scleritis in the patient with squamous cell carcinoma and anterior uveitis with hypopyon in the patient with intraocular metastasis.
Neoplastic masquerade syndrome was diagnosed in two patients with anterior uveitis and necrotizing scleritis respectively. Patients older than 50 years of age with unexplained anterior uveitis, hypopyon, scleritis with an incomplete therapeutic response, should undergo evaluation for neoplastic MS.
Malignant masquerade syndrome, ocular inflammation
UNIFESP - Sao Paulo - Brasil
Ever Ernesto Caso Rodriguez, Melina MORALES