Ocular metastasis from diffuse large B-cell lymphoma masquerading as atypical Vogt–Koyanagi–Harada disease

We report a rare case of unilateral ocular metastasis in a 42-year-old woman with diffuse large B-cell lymphoma (DLBCL) in systemic remission, presenting with features resembling the acute uveitic phase of Vogt–Koyanagi–Harada (VKH) disease. The patient presented with painless vision loss and photophobia in the left eye for 1 month. Multimodal imaging revealed subretinal and intraretinal fluid, increased choroidal structural changes, and diffuse late leakage on fluorescein angiography (FA), mimicking VKH. Orbital magnetic resonance imaging (MRI) demonstrated posterior scleral enhancement, and follow-up cranial MRI 1 month later revealed temporal bone infiltration consistent with cranial and orbital metastases. Without systemic therapy, partial regression of the ocular findings and visual improvement occurred over 4 months. Ocular involvement in DLBCL rarely mimics VKH, and the recognition of such atypical presentations is crucial, as they may be the first clinical sign of central nervous system recurrence and significantly impact the patient's prognosis.