PDF(Pubmed)
Abstract：
This is a case report of Epstein-Barr virus (EBV) uveitis confirmed via aqueous humor polymerase chain reaction (PCR) and metagenomics. This 72-year-old male with a history of diabetes and herpes zoster complained of redness and blurred vision in his right eye for eight months. Mild conjunctival injection, anterior chamber cells, mutton-fat keratic precipitates, and vitreous haze were noted. Fluorescein angiography revealed dye leakage from retinal vessels without retinal ischemic changes. Only the serum anti-cytomegalovirus (CMV) IgG was positive while the aqueous humor PCR for VZV (Varicella-zoster virus), HSV (Herpes simplex viruses), CMV, and EBV was initially negative. Inflammation recurred and vitreous haze worsened after discontinuing nine-month topical ganciclovir and oral prednisolone. the aqueous humor PCR was repeated due to persistent low-grade inflammation. The EBV PCR turned out to be positive. Shotgun metagenomics revealed 1459 classified sequences (1.62%) and confirmed the EBV infection. Topical ganciclovir and methylprednisolone treatment was resumed. Conjunctival injection improved while pigmented keratic precipitates lessened. Elderly patients with diabetes or under immunosuppression may be susceptible to chronic uveitis associated with subsequent EBV infection. Repeated aqueous humor PCR and shotgun metagenomics are important tools in the diagnosis of this case of chronic indolent panuveitis.
摘要：
这是通过房水聚合酶链反应（PCR）和宏基因组学证实的爱泼斯坦-巴尔病毒（EBV）葡萄膜炎的病例报告。这位72岁的男性，有糖尿病和带状疱疹病史，他抱怨右眼发红和视力模糊八个月。轻度结膜注射，前房细胞,羊肉脂肪角质沉淀物，并注意到玻璃体雾。荧光素血管造影术显示染料从视网膜血管渗漏，无视网膜缺血改变。只有血清抗巨细胞病毒（CMV）IgG阳性，而房水PCR检测VZV（水痘带状疱疹病毒），HSV（单纯疱疹病毒），CMV,EBV最初是阴性的。停用9个月局部更昔洛韦和口服泼尼松龙后，炎症复发，玻璃体雾霾恶化。由于持续性低度炎症,重复进行房水PCR.EBVPCR结果为阳性。鸟枪宏基因组学揭示了1459个分类序列（1.62％），并证实了EBV感染。恢复局部更昔洛韦和甲基强的松龙治疗。结膜注射改善，而色素沉着的角膜沉淀减少。患有糖尿病或免疫抑制的老年患者可能易患与随后的EBV感染相关的慢性葡萄膜炎。重复房水PCR和shot弹枪宏基因组学是诊断这种慢性惰性全葡萄膜炎的重要工具。
