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. 2019 Apr 1;137(4):435-438.
doi: 10.1001/jamaophthalmol.2018.6185.

Association of Ocular Inflammation and Rubella Virus Persistence

John A Gonzales  1   2 , Armin Hinterwirth  1 , Jessica Shantha  3 , Kaidi Wang  1   2 , Lina Zhong  1 , Milo Cummings  1 , Ying Qian  4 , Michael R Wilson  5   6 , Nisha R Acharya  1   2 , Thuy Doan  1   2
Affiliations

Association of Ocular Inflammation and Rubella Virus Persistence

John A Gonzales et al. JAMA Ophthalmol. .

Abstract

Importance: Metagenomic deep sequencing (MDS) demonstrates that persistent and active rubella virus (RV) infection is associated with Fuchs heterochromic iridocyclitis (FHI).

Objective: To assess the utility of MDS in identifying RV infection in patients with uveitis.

Design, setting, and participants: This case series assessed 6 patients diagnosed by MDS with RV-associated uveitis at a tertiary uveitis referral center in the United States.

Exposures: Prior RV infection.

Main outcomes and measures: Clinical examination findings, slitlamp photography, corneal confocal imaging, and infectious pathogen genome obtained from RNA sequencing.

Results: Six white men (age range, 36-61 years) were diagnosed with RV-associated uveitis by MDS. Three patients exhibited iris heterochromia associated with their uveitis in classic FHI fashion. The other 3 patients had less classic FHI features and exhibited anterior vitritis. Three patients had in vivo corneal confocal microscopy, with 2 demonstrating stellate keratic precipitates in addition to endothelial infiltration, spotlike holes, and enlarged intercellular boundaries. Of these 3 patients, 1 patient exhibited polymorphism and polymegathism of the endothelial cells.

Conclusions and relevance: These findings suggest that persistent RV infection is associated with recurrent or chronic anterior or anterior-intermediate uveitis as well as corneal endothelial cell damage. Ophthalmologists should consider RV infection as a potential cause of hypertensive anterior and intermediate uveitis.

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Conflict of interest statement

Conflicts of Interest: Dr Shantha reports other financial support from Santen, Inc, and grants from Building Interdisciplinary Careers inWomen's Health of the National Institutes of Health outside the submitted work. Dr Acharya reports personal fees from AbbVie, Inc, and Santen, Inc, outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Confocal Images From the Patient Cohort
Confocal images of the affected right eye (A) and unaffected left eye (B) of patient 3 showing infiltration of endothelial cells with endothelial infiltration (blue arrowhead) and spotlike holes (yellow arrowhead). Confocal images of unaffected right eye (C) and affected left eye (D) of patient 5 showing polymegathism and polymorphism as well as infiltration of endothelial cells (blue arrowhead).
Figure 2.
Figure 2.. Rubella Virus (RV) Genomes From the Patient Cohort
Rubella virus sequences from 5 patients assembled against the reference RV genome. CDS indicates coding sequence; RdRp, RNA-dependent RNA polymerase.
See this image and copyright information in PMC

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