Epstein-Barr virus uveitis after intravitreal triamcinolone injection
Abstract
Purpose: To report a case of Epstein-Barr virus (EBV) uveitis after intravitreal triamcinolone injection.
Methods: Observational case report.
Results: A 66-year-old male presented with bilateral intermediate uveitis, left macular branch retinal vein occlusion, and left macular edema 3 months following acute infectious mononucleosis. He received systemic prednisolone, methotrexate, and intravitreal bevacizumab with partial response. Intravitreal triamcinolone was given for recurrent macular edema, which led to the development of severe panuveitis with positive EBV PCR in aqueous humour. This was successfully treated with high-dose systemic valaciclovir and topical prednisolone.
Conclusion: Non-infectious uveitis may become infectious following intravitreal steroid administration triggering intraocular viral replication. Intraocular fluid should be tested in cases which are suspicious for infection and EBV should be considered a differential diagnosis, particularly if PCR is negative for more common viral etiologies.
References
Heiligenhaus A, Dohrmann J, Koch J, et al. Severe bilateral panuveitis in a patient with asymptomatic Epstein-Barr virus infection. Eye. 2001;15(6):792.
Usui M, Sakai J. Three cases of EB virus-associated uveitis. Int Opthalmol. 1990;14:371-376.
Doan T, Wilson MR, Crawford E, et al. Illuminating uveitis: metagenomic deep sequencing identifies common and rare pathogens. Genome Med. 2016;8(1):90-98.
Groen-Hakan F, Van Der Eijk AA, Rothova A. The Usefulness of Aqueous Fluid Analysis for Epstein-Barr Virus in Patients with Uveitis. Ocul Immunol Inflamm. 2018. https://doi.org/10.1080/09273948.2018.1543709.
Keorochana N. A case report of Epstein-Barr virus-associated retinal vasculitis: successful treatment using only acyclovir therapy. Int Med Case Rep J. 2016;9:213-218.
Cacopardo B, Nunnari G, Mighini MT, et al. Fatal hepatitis during Epstein-Barr virus reactivation. Eur Rev Med Pharmacol Sci. 2003;7:107-109.
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