METHODS: An 80-year-old female who had been treated with prednisolone at 5 mg/day and methotrexate at 2 mg/week for rheumatoid arthritis visited our hospital because of blurred vision in her left eye. Her left visual acuity was 20/50, and extensive white-yellowish retinal lesions at the temporal periphery with retinal hemorrhages were seen through vitreous haze. The DNA sequence of EBV, but not of HSV, VZV, or cytomegalovirus, was detected by a polymerase chain reaction (PCR) assay in the aqueous humor (4.2 × 106 copies/ml), with EBV also being positive in serum (3.5 × 102 copies/ml). The patient received 2 mg of intravitreal ganciclovir injections twice with a 3-day interval and intravenous infusion of acyclovir at 750 mg/day for 7 days; however, the retinal white lesions expanded rapidly, then dose of prednisolone was increased (40 mg/day) and vitrectomy was performed 10 days after the initial visit. After the surgery, the retinal lesion continued to enlarge. Vitreous samples showed high copies of EBV (1.2 × 108 copies/ml). Following treatment with intravenous foscarnet (4800 mg/day), which replaced the acyclovir application, the retinal white lesions gradually diminished, leaving retinal scars. To date, the patient has developed no retinal detachment and shows visual acuity over 6/60 in the left eye along with silicone oil.
CONCLUSIONS: We experienced a case of EBV-ARN that was refractory to systemic acyclovir and topical ganciclovir but responded effectively to systemic foscarnet after vitrectomy. Although the clinical management remains challenging in this disease, foscarnet is considered to be one of the candidate drugs for EBV infections.
方法:一名80岁女性因左眼视力模糊,曾接受5毫克/天的泼尼松龙和2毫克/周的甲氨蝶呤治疗类风湿关节炎。她的左视力为20/50,通过玻璃体浑浊可以看到颞叶周围广泛的白色黄色视网膜病变并伴有视网膜出血。EBV的DNA序列,但不是HSV,VZV,或者巨细胞病毒,通过聚合酶链反应(PCR)测定法在房水(4.2×106拷贝/毫升),EBV在血清中也是阳性的(3.5×102拷贝/ml)。患者接受2mg玻璃体内注射更昔洛韦2次,间隔3天,并以750mg/天静脉输注阿昔洛韦7天;然而,视网膜白色病变迅速扩张,然后增加泼尼松龙的剂量(40mg/d),并在初次访视后10天进行玻璃体切除术.手术后,视网膜病变继续扩大。玻璃体样品显示EBV的高拷贝(1.2×108拷贝/ml)。静脉注射膦甲酸钠(4800毫克/天)治疗后,取代了阿昔洛韦的应用,视网膜白色病变逐渐减少,留下视网膜疤痕.迄今为止,患者未出现视网膜脱离,左眼视力超过6/60,并伴有硅油。
结论:我们经历了一例EBV-ARN,对全身性阿昔洛韦和局部更昔洛韦难治性,但对玻璃体切除术后的全身性膦甲酸钠有效反应。尽管这种疾病的临床管理仍然具有挑战性,膦甲酸钠被认为是EBV感染的候选药物之一。