Behind the mask, a great ocular trickster: Masquerade syndrome in recurrent carcinoma

Background: Masquerade syndrome comprises neoplastic and non-neoplastic conditions that mimic ocular inflammation and may be difficult to distinguish from uveitis, particularly in immunocompromised patients.

Case Report: A 44-year-old male with recurrent head and neck carcinoma with prior chemotherapy presented with left eye swelling with severe systemic weakness & bilateral pedal edema. Ophthalmic examination revealed left sided progressive conjunctival congestion & chemosis, corneal edema & ring-like corneal opacity. In view of the underlying malignancy & atypical ocular findings, ocular examinations using had held slit lamp examination & bedside B scan was done & patient was started on steroids were initiated & ocular imaging was planned; however, the patient's systemic condition rapidly deteriorated with altered sensorium, profound hypotension, anuria & features of septic shock. Peripheral smear showed marked neutrophilic leukocytosis with left shift and toxic changes. The patient succumbed to septic shock on the third day.

After the demise of the patient AC paracentesis was done & masquerade like picture was ruled out.

Conclusion: Masquerade syndrome should be considered in patients with malignancy and immunosuppression who develop atypical, rapidly progressive ocular findings mimicking uveitis. Early recognition may facilitate appropriate investigation and management.

Keywords: Masquerade Syndrome; Malignancy; Pseudohypopyon; Chemosis; Uveitis Mimic.