A case report of Epstein-Barr virus-associated retinal vasculitis: successful treatment using only acyclovir therapy

Abstract

The purpose of this study was to describe a presumed case of Epstein-Barr virus (EBV)-associated retinal vasculitis in a 42-year-old female with sudden unilateral vision loss and successful treatment with acyclovir therapy. Diagnostic vitreous biopsy of the right eye was performed to test for EBV and other known infectious causes of retinitis and evaluate vitreous cells and serological testing. Vitreous polymerase chain reaction viral DNA testing result was positive for EBV but negative for herpes simplex virus, varicella-zoster virus, and cytomegalovirus. Serologic testing was negative for toxoplasma gondii, syphilis, tuberculosis, and HIV. Histopathologic analysis of vitreous cells revealed atypical lymphocytes. Fluorescein angiography showed disk leakage, occluded retinal artery, peripheral vascular leakage, and ischemic area of the right eye. Intravenous acyclovir, 10 mg/kg/d, was prescribed for 14 days followed by oral acyclovir for 3 months. All lesions have become quiet. EBV may be a cause of retinal disease, and intravenous acyclovir is a successful treatment choice.

Keywords: Epstein-Barr virus; acyclovir; retinal vasculitis; treatment.

Figure 1

Dense vitritis.

Figure 2

Intraoperative findings were dense vitritis, fibrous tissue on superior disk with diffuse periphery sclerotic vessels, and sheathing of both artery and vein.

Figure 3

Fluorescein angiography. Notes: (A) Photo fundus showed fibrous band on hyperemia optic disk. (B) Optic disk showed leakage in early phase. (C–D) Ischemic area was observed at periphery with occluded retinal artery and leakage retinal vein in all quadrants of the right eye.

Figure 4

Panretinal photocoagulation of the right eye at ischemic area was performed. Notes: (A) Posterior pole. (B) Laser scar at periphery.

Figure 5

Post-IV acyclovir after 14 days of therapy. Notes: (A) Laser scar. (B) Repeated FA, peripheral retinal vein still has leakage. (C–D) Late phase. Abbreviation: IV, intravenous; FA, fluorescein angiography.

Figure 6

Post-IV acyclovir after 4 weeks of therapy. Notes: (A) Photo fundus showed optic disk edema decreased. (B–D) FA confirmed retinal phlebitis improved. Abbreviation: IV, intravenous; FA, fluorescein angiography.

Figure 7

Post-acyclovir after 3 months of therapy. Notes: (A) Normal optic disk. (B–D) Retinal vascular leakage was not observed.

Figure 8

Post-acyclovir after 6 months of therapy (after 3 months of discontinued oral acyclovir). Notes: (A) There was no vitreous haze and disk edema. (B) Optic disk showed no leakage. (C–D) Periphery has become quiet.