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P. I. Murray, C. Fink, D. Trivedi; The Significance of EBV DNA Positivity in Intraocular Fluid Samples From Uveitis Patients. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2908.
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Herpes viruses are well-recognised causes of uveitis. Varicella zoster virus (VZV), herpes simplex virus (HSV) and cytomegalovirus (CMV) are the most frequent agents responsible. Detecting specific viral DNA in intraocular fluid samples using the polymerase chain reaction (PCR) is the standard way of identifying the infectious agent. Epstein Barr Virus (EBV) is an unusual cause of uveitis and we wished to investigate the role of EBV in patients with uveitis.
A total of 159 aqueous and 67 vitreous samples were obtained from patients with suspected infectious uveitis. All underwent PCR testing for a number of infectious agents including VZV, HSV, CMV, EBV, and where appropriate toxoplasma, 16SrRNA bacterial gene, and 18S rRNA fungal gene.
We identified 15 patients who were positive for EBV DNA in aqueous and /or vitreous samples. In all cases it was the clinical impression that this organism was not the causal agent. In 7 patients another infectious agent was felt to be responsible for the uveitis (4 with positive toxoplasma DNA, 1 positive VZV DNA, 1 positive CMV DNA, 1 positive syphilis serology). 6 patients were also HIV positive and another 4 patients were also likely to be immunosuppressed (2 had SLE on systemic immunosuppression, 1 had metastatic adenocarcinoma of the lung, 1 diabetic). Of the 6 HIV positive patients, 2 were also positive for toxoplasma DNA, and another 2 showed higher levels of EBV in vitreous samples as compared with blood and both were subsequently diagnosed with primary CNS non-Hodgkin lymphoma.
EBV as a cause of uveitis is unusual, and the presence of EBV in intraocular samples may imply underlying immunosuppression, including possible HIV infection. The finding of intraocular EBV DNA levels higher than found in blood in HIV patients should alert one to the possibility of a primary CNS non-Hodgkin lymphoma.
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