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Volume 60
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Case Report

Epstein–Barr Virus Uveitis Confirmed via Aqueous Humor Polymerase Chain Reaction and Metagenomics—A Case Report

by
Ning-Yi Hsia
1,2,
Henry Bair
1,3,
Chih-Ying Lin
1,
Chun-Ju Lin
1,2,4,*,†,
Chun-Ting Lai
1,2,
Chieh-Min Chang
5,
Jane-Ming Lin
1 and
Yi-Yu Tsai
1,2,4,*,†
1
Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
2
Department of Optometry, Asia University, Taichung 40447, Taiwan
3
Byers Eye Institute, School of Medicine, Stanford University, Stanford, CA 94303, USA
4
School of Medicine, College of Medicine, China Medical University, Taichung 404327, Taiwan
5
Precision Medical Center, China Medical University, Taichung 404327, Taiwan
*
Authors to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Medicina 2024, 60(1), 97; https://doi.org/10.3390/medicina60010097
Submission received: 12 November 2023 / Revised: 3 December 2023 / Accepted: 11 December 2023 / Published: 4 January 2024
(This article belongs to the Special Issue Clinical Profile and Treatment Response of Patients with Ocular Inflammation)
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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.
Keywords: Epstein–Barr virus; polymerase chain reaction; metagenomics; uveitis Epstein–Barr virus; polymerase chain reaction; metagenomics; uveitis

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MDPI and ACS Style

Hsia, N.-Y.; Bair, H.; Lin, C.-Y.; Lin, C.-J.; Lai, C.-T.; Chang, C.-M.; Lin, J.-M.; Tsai, Y.-Y. Epstein–Barr Virus Uveitis Confirmed via Aqueous Humor Polymerase Chain Reaction and Metagenomics—A Case Report. Medicina 2024, 60, 97. https://doi.org/10.3390/medicina60010097

AMA Style

Hsia N-Y, Bair H, Lin C-Y, Lin C-J, Lai C-T, Chang C-M, Lin J-M, Tsai Y-Y. Epstein–Barr Virus Uveitis Confirmed via Aqueous Humor Polymerase Chain Reaction and Metagenomics—A Case Report. Medicina. 2024; 60(1):97. https://doi.org/10.3390/medicina60010097

Chicago/Turabian Style

Hsia, Ning-Yi, Henry Bair, Chih-Ying Lin, Chun-Ju Lin, Chun-Ting Lai, Chieh-Min Chang, Jane-Ming Lin, and Yi-Yu Tsai. 2024. "Epstein–Barr Virus Uveitis Confirmed via Aqueous Humor Polymerase Chain Reaction and Metagenomics—A Case Report" Medicina 60, no. 1: 97. https://doi.org/10.3390/medicina60010097

APA Style

Hsia, N.-Y., Bair, H., Lin, C.-Y., Lin, C.-J., Lai, C.-T., Chang, C.-M., Lin, J.-M., & Tsai, Y.-Y. (2024). Epstein–Barr Virus Uveitis Confirmed via Aqueous Humor Polymerase Chain Reaction and Metagenomics—A Case Report. Medicina, 60(1), 97. https://doi.org/10.3390/medicina60010097

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