Acute Retinal Necrosis Associated With Epstein-Barr Virus

Abstract

cute retinal necrosis (ARN) is a syndrome characterized by progressive intraretinal inflammation and necrosis. The clinical diagnosis is frequently supported by the identification of the causative infectious agent, most commonly varicella-zoster virus (VZV), though herpes simplex virus (HSV) types 1 and 2, cytomegalovirus, and Epstein-Barr virus (EBV) have also been implicated. 1,2 Epstein-Barr virus, a double-stranded DNA virus transmitted by oral secretions, infects more than 90% of humans. 3 IMPORTANCE Acute retinal necrosis (ARN) is an infectious retinitis primarily caused by the herpesviruses. Although the Epstein-Barr virus (EBV) has been implicated as a cause of ARN, to our knowledge, there has been no histopathologic documentation. We report the clinical history and histopathologic confirmation that EBV can cause ARN.OBSERVATIONS Clinical course and histopathology of a patient diagnosed with ARN caused by infection with EBV confirmed by molecular pathology.CONCLUSIONS AND RELEVANCE Epstein-Barr virus is a recognized cause of intraocular inflammation and has been implicated as a possible cause of ARN. However, to our knowledge, tissue demonstration of EBV in a patient with ARN has not previously been reported. We identified the organism in the necrotic retina of a patient receiving immunosuppression because of idiopathic pulmonary fibrosis.

Infectious Uveitis

“…[ 12 ] EBV-associated ARN has also been shown histopathologically in one case, although clinically, this case appeared to involve much more extensive hemorrhagic retinitis than in typical ARN. [ 13 ] VZV and HSV-1 associated ARN are more commonly found in older and middle-aged patients whereas HSV-2 associated ARN is more common in children and young adults. [ 14–16 ]…”

Viral retinitis: diagnosis and management in the era of biologic immunosuppression: A review

“…There is no known racial or gender predilection . EBV has infrequently been implicated as a causative agent and is usually found in conjunction with VZV or immunocompromise . CMV is a rare cause of ARN …”

“…It has been identified using PCR from the ocular fluids of eyes with anterior uveitis, vitritis, vasculitis and retinitis, and in 70% of normal cadaveric eyes . Reports have also identified its presence in eyes with ARN, mostly concomitantly with HSV or VZV, though there have also been cases where it was the only identified pathogen . Schaal et al demonstrated EBV DNA in the retinal cells of a patient with ARN, supporting its role in disease rather than as an indicator of lymphocyte migration.…”

Acute Retinal Necrosis with Multiple Viral Infections: A Case Report

“…It has been suggested that the pathogenesis is closely tied to viral infection, most commonly with varicella-zoster virus (VZV) and herpes simplex virus (HSV), though there are some cases where the infectious agent has been cytomegalovirus (CMV) or Epstein-Barr virus (EBV) [3]. Although EBV infection in ARN is rarely found alone, but rather co-existing with VZV infection [4], a recent report has demonstrated EBV as the only virus in the retina of a patient with ARN [5]. The most common therapeutic approach for ARN is anti-viral therapy immediately after diagnosis [2]; in previous reports, early vitrectomy with intravitreal lavage using anti-viral medication was associated with a lower incidence of secondary retinal detachment [3].…”