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Charles M. Calvo, Steven Friedlander, Julia Hilliard, Raymond Swarts, Jarl Nielsen, Hardeep Dhindsa, Robert Welch, Richard Dix; Case Report: Reactivation Of Latent B Virus (Macacine Herpesvirus 1) Presenting As Bilateral Uveitis, Retinal Vasculitis And Necrotizing Herpetic Retinitis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2975.
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We report a case of viral retinitis and vasculitis from the reactivation of a latent B virus infection - an infection transmitted from macaque monkeys to humans with an 80% untreated mortality rate due to devastating encephalomyelitis.
Fluorescein angiography, PCR of vitreous and conjunctival samples, serum B virus serology and wide field retinal photography were performed.
A 41-year-old male presented with decreased vision and pain in his left eye for 3 weeks. His past medical history was remarkable for being 1 of only 23 known survivors of B virus infection which was acquired from a macaque monkey bite in 1981 leading to meningitis and encephalitis. Fundus examination of the left eye revealed peripheral retinal vascular sheathing and sclerotic vessels for nearly 360°. Inferiorly, a white plaque on the retinal surface was seen which appeared to be inflammatory in nature. Two areas of chorioretinal scarring in the superior periphery were also seen. The fundus of the right eye was normal. Fluorescein angiography revealed hyperfluorescence at the optic disk and sausaging of peripheral vessels. The patient was treated with intravitreal and intravenous ganciclovir. PCR of vitreous samples were positive, with viral load decreasing following antiviral therapy. Serum serology was also remarkable for increased B virus high affinity IgG titers. This individual was seropositive for B virus antibody previously and had been monitored for antibody for 13 years prior to the currently described episode. Six months later the patient developed a nearly identical pan-uveitis and retinitis in his fellow right eye.
To our knowledge, this case of sequential, bilateral retinal disease is the first documented case of B virus latency and reactivation in a human. This demonstrates that reactivation may present as necrotizing herpetic retinitis, very similar to common infections with VZV and HSV. Recent use of antiviral therapy has increased the survival of infected patients, therefore this patient may be the first of a growing number of survivors to present with an ocular reactivation. In conclusion, a B virus infection should be considered as a diagnosis in primate or virology workers who present with an ophthalmic complaint.
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