Maryam I. Toma AL Najjar
McGill University, Jordan
Title: Bilateral anterior uveitis due to latent reactivation of varicella zoster virus
Biography
Biography: Maryam I. Toma AL Najjar
Abstract
Introduction: Latent reactivation of Varicella Zoster Virus (VZV) infection is one of the causes of anterior uveitis. The patient is usually presented with unilateral iridocyclitis with elevation of intraocular pressure, and later sequences of sectorial iris atrophy after recurrent attacks.
Case presentation: We are reporting a case of unusual presentation of bilateral anterior uveitis due to latent reactivation of VZV in an immunocompetent patient. A 44-year-old man was referred to our hospital, with a history of three weeks of bilateral eye pain, redness and photophobia. The patient had been treated in another clinic by topical steroid eye drops without improvement.
On examination, the best corrected visual acuity was 20/60 in each eye. Anterior segment examination: marked ciliary injection, corneal epithelial edema, fine keratic precipitates, flare +2, and anterior chamber reaction was +3 cells in each eye and intraocular pressure was 19 mmHg in each eye. Fundus examination was within normal
The patient underwent full review of systems and complete work up to exclude infectious and autoimmune diseases. After three days, the blood tests revealed a high titer of VZV, more than 2000 mIU/ml. The other blood tests returned within normal limits.
Treatment: We prescribed the patient oral Valacyclovir 1 gm twice daily and besides the oral treatment, we prescribe topical steroid eye drops, antiglaucoma eye drops on the second visit as the intraocular pressure spiked to 35 mmHg in the right eye and 38 mmHg in the left eye.
Follow up: On examination, the best correct visual acuity after three weeks of oral and topical treatment, the best corrected visual acuity had been improved to 20/20 in each eye, anterior segment examination showed clear anterior chamber with fine pigmentation on endothelium, intraocular pressure was within normal limits.
We taper the topical treatment and we kept the oral valacyclovir till the next visit in two months.