Epstein-Barr viral corneal stromal keratitis occurring during rheumatoid arthritis treatment: a case report

Yamashita, Kazuya; Sato, Rio; Fukumoto, Ryuki; Ofuji, Yoshiko; Nagamoto, Toshiyuki; Kubono, Hirohisa; Kawamura, Marenori; Suzuki, Kotaro

doi:10.1186/s12886-022-02257-6

Cited by 6 publications

(6 citation statements)

References 28 publications

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“…Epstein-Barr virus, or human herpesvirus-4, is considered a relatively rare cause of keratitis in human patients and this keratitis can develop with or without clinically evident infectious mononucleosis. 32 The keratitis associated with EBV infection in humans can be unilateral or bilateral and can present with ulcerative or nonulcerative lesions. [33][34][35] Gammaherpesviruses are commonly associated with lymphoproliferative disorders and lymphoma in a variety of species.…”

Section: Discussionmentioning

confidence: 99%

“…There are gammaherpesviruses in other host species that are associated with keratitis, including Epstein–Barr virus (EBV) in humans. Epstein–Barr virus, or human herpesvirus‐4, is considered a relatively rare cause of keratitis in human patients and this keratitis can develop with or without clinically evident infectious mononucleosis 32 . The keratitis associated with EBV infection in humans can be unilateral or bilateral and can present with ulcerative or nonulcerative lesions 33–35 …”

Section: Discussionmentioning

confidence: 99%

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Macrodendritic ulcerative keratitis and conjunctival lymphoid hyperplasia in horses with equine herpesvirus‐2 and equine herpesvirus‐5 infections

Ledbetter,

Cutler,

Irby

2023

Veterinary Ophthalmology

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ObjectiveThe aim of this study was to describe the clinical, confocal microscopic, histologic, and virologic features of horses with macrodendritic ulcerative keratitis and conjunctival lymphoid hyperplasia associated with equine herpesvirus‐2 and equine herpesvirus‐5 infection.Animal StudiedFour foals with bilateral ocular disease.ProceduresComplete ophthalmic examination was performed for each horse, and corneal samples were collected for cytology and microbiologic evaluation, including virus isolation and molecular diagnostics for the equine herpesviruses. In vivo confocal microscopy examination of the cornea was performed in two horses. Conjunctival biopsies for histopathology were collected from two horses with nodular conjunctival thickening.ResultsEach horse had bilateral, large, superficial dendritic corneal ulcerations that covered extensive regions of the corneal surface. Corneal in vivo confocal microscopy examination in two horses detected inflammatory cells and populations of morphologically abnormal corneal epithelial cells adjacent to the ulcerations. The abnormal epithelial cells included round, relatively small, hyperreflective cells intermixed with elongated, enlarged, hyperreflective cells. Equine herpesvirus‐2 was isolated from corneal samples of 2 horses and detected by PCR assay in the other two horses. Equine herpesvirus‐5 was also detected by PCR assay in three of the horses. Conjunctival histopathology identified predominantly lymphocytic infiltrates. The macrodendrites and conjunctival masses resolved with topical antiviral therapy (cidofovir or idoxuridine) in all horses and did not recur.Conclusions and Clinical RelevanceThe equine gammaherpesviruses may be associated with the development of macrodendritic ulcerative keratitis and conjunctival lymphocytic masses in foals. In vivo confocal microscopy of horses with macrodendrites revealed similar findings to other host species with herpetic dendritic keratitis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Macrodendritic ulcerative keratitis and conjunctival lymphoid hyperplasia in horses with equine herpesvirus‐2 and equine herpesvirus‐5 infections

Ledbetter,

Cutler,

Irby

2023

Veterinary Ophthalmology

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“…It is known that EBV can cause uveitis and scleritis. 5,6 Another possibility is that the nasopharyngeal EBV-driven PTLD might have caused a secondary scleritis, but I could not find any cases in the literature. There are reports in the literature of EBV causing scleritis, so I believe the patient had two separate and regionally localized manifestations of an active EBV infection and not a direct effect of the EBV PTLD.…”

Section: Dr Jose S Pulido (Philadelphia Pennsylvania)mentioning

confidence: 99%

“…[7][8][9] The reports in the literature of two cases of scleritis associated with EBV were both reported as necrotizing scleritis. 5,6 Based on this, Dr. Pulido's assessment is that the EBV may have caused the scleritis, which it may well have. However, if this was an infective viral scleritis, response to high doses of steroids alone is somewhat unexpected.…”

Section: Editor's Notementioning

confidence: 99%

Diagnostic and Therapeutic Challenge: Posterior Scleritis

Li,

Miller,

Brucker

et al. 2023

Retina

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“…Каспаров различают отдельную форму глубокого кератита -герпетическую язву роговицы, при которой наблюдается колонизация язвенного дефекта бактериальной и/или грибковой флорой. В свете информации, полученной зарубежными исследователями при применении метода полимеразной цепной реакции (ПЦР), стало очевидно, что помимо ВПГ герпетические вирусы с выраженной лимфоцитотропностью также могут играть роль в развитии изъязвлений роговицы: вирус Эпштейна -Барр (ВЭБ) и вирус герпеса человека 6-го типа (ВГЧ-6) [4][5][6]. Отечественные публикации Е.А.…”

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Stromal Herpetic Keratitis with Ulceration Associated with Reactivation of Epstein–Barr Virus and Human Herpes Virus Type 6: Experience of Diagnosis and Therapy

Чернакова¹,

Клещева²,

Turdalieva³

2022

Oftalʹmologiâ

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Objective: to study the clinical manifestations of herpetic stromal keratitis with ulceration associated with EBV and HHV-6 reactivation.Patients and methods. 172 patients with anterior ophthalmic herpes were under observation, of which 43 patients had herpetic stromal keratitis with ulceration with an average duration of complaints of more than 60 days. Tear, saliva, blood and urine samples were used as a material for PCR (qualitative and quantitative) for the presence of HSV, VZV, CMV, EBV, HHV-6, HHV-7 DNA. Local therapy of the acute period included instillation of antiviral, anti-inflammatory agents and lubricants. Systemic antiherpetic therapy included oral use of selective nucleoside analogues: valacyclovir and famciclovir in increased daily dosages.Results. 87 cumulative positive results were obtained, of which the proportion of EBV and HHV-6 DNA detection was 23 % and 28 %. Complex local therapy with the inclusion of heparin-containing lubricant and a drug containing 5 % dexpanthenol (“Corneregel”) combined with systemic therapy with nucleoside analogues in increased daily dosages led to complete relief of objective symptoms within 14 to 28 days.Conclusions. EBV and HHV-6 were detected in more than 50 % of cases, which determines systemic antiviral therapy in increased daily dosages and a prolonged course. The pathogenesis of ulcerative defects may be associated with the direct reactivation of HHV-6 and EBV, which requires the use of active reparative therapy from the first days of curation. The phenomenon of a transient viral “surge” detected by PCR during disease course can be observed by adequate systemic therapy and is a normal laboratory pattern indicating the correct tactics.

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Epstein-Barr viral corneal stromal keratitis occurring during rheumatoid arthritis treatment: a case report

Cited by 6 publications

References 28 publications

Macrodendritic ulcerative keratitis and conjunctival lymphoid hyperplasia in horses with equine herpesvirus‐2 and equine herpesvirus‐5 infections

Macrodendritic ulcerative keratitis and conjunctival lymphoid hyperplasia in horses with equine herpesvirus‐2 and equine herpesvirus‐5 infections

Diagnostic and Therapeutic Challenge: Posterior Scleritis

Stromal Herpetic Keratitis with Ulceration Associated with Reactivation of Epstein–Barr Virus and Human Herpes Virus Type 6: Experience of Diagnosis and Therapy

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