Unilateral eyelid swelling and ptosis caused by dural arteriovenous fistula in an infant.

ous tissues of the thorax and abdomen. A biopsy specimen of his skin lesions showed nonspecific inflammatory cell infiltration of the dermis. A bone marrow biopsy specimen revealed hypercellularity with trilineage hyperplasia consistent with a peripheral destructive process. The blood smear demonstrated several atypical lymphocytes with convoluted nuclei. Cerebrospinal fluid examination re sults were normal, while a lung biopsy specimen revealed large, atypical CD20-positive and CD3-negative lymphocytes filling the lumen of the capillaries in the alveolar septae (Figure 2B and C). These findings were diagnostic of malignant intravascular lymphoma of B-cell phenotype (intravascular lymphomatosis). Aregimenofhyper-CVAD(cycle 1: cyclophosphamide,vincristine,doxorubicin,anddexamethasone)chemotherapy, intrathecalmethotrexateand cytarabine, and methylprednisolone was initiated 10 days after initial examination. A week later, there was a marked improvement invisualacuity (20/20 OU) and resolution of serous detachments and choroidal thickening, shown by repeat fluorescein angiography and indocyanine green angiography (Figure 1E and F). The patientcontinuedtodowell2months after starting therapy.