Real-time polymerase chain reaction in recurrent cytomegalovirus anterior uveitis

Abstract

Purpose: Cytomegalovirus (CMV) has been reported to cause anterior uveitis in the immunocompetent people. Recurrence of this viral uveitis poses a mangement dilemma. With real-time polymerase chain reaction(PCR), it is possible to confirm the clinical diagnosis. We report a case of recurrent CMV anterior uveitis documented by real-time PCR.

Observations: A 42 year old man developed PCR proven CMV anterior uveitis. It resolved with oral and topical antivirals but recurred after ten months. The recurrence was controlled by restarting the oral antivirals. Real-time PCR was used to sequentially document the inital infection, the subsequent resolution and the recurrence of the infection.

Conclusions and importance: Real-time PCR is a useful tool in the management of CMV anterior uveitis.

Keywords: Cytomegalovirus; Hypertensive anterior uveitis; Real-time polymerase chain reaction.

Fig. 1

Large keratic precipitates seen in the central cornea of the left eye at the first visit.b)slit lamp photograph of the left eye in remission.c)slit lamp photo of the left eye during recurrence with high copies of viral DNA in real time PCR.

Fig. 2

Real time polymerase chain reaction report showing exponential rise in viral DNA copies suggestive of active replication of Cytomegalovirus along with defined standards: Standard 1/S1 (red arrow), Standard 3/S3 (yellow arrow), standard 4/S4 (Blue arrow) and test sample (SN No 1798/17: green arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 3

Real time polymerase chain reaction report for detection of load of Cytomegalo virus along with defined standards: Standard 1/S1 (red arrow), Standard 4/S4 (yellow arrow), and test sample negative for CMV RTPCR (SN No 2282/17: green arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 4

Real time polymerase chain reaction report showing increase in viral DNA copies suggestive reactivation of Cytomegalo virus along with defined standard: Standard 1//S1 (red arrow), test sample (SN No 1228/18: yellow arrow) and negative control (purple arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)