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Heather Tamez, Stephen Kim; Ocular Inflammation in Patients with Herpes Simplex Virus IgM Positivity: A Case Series. Invest. Ophthalmol. Vis. Sci. 2017;58(8):515.
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© ARVO (1962-2015); The Authors (2016-present)
To report the course of fourteen patients with ocular inflammation and positive IgM herpes simplex virus serology.
Fourteen cases were identified from the uveitis clinic at Vanderbilt Eye Institute from 2013 to 2016. All cases were reviewed retrospectively after obtaining Internal Review Board approval.
Nine females and five males were identified. The mean age at initial presentation was 51 years. Five patients presented with anterior uveitis, three patients presented with panuveitis, and one patient each presented with anterior and intermediate uveitis, intermediate uveitis, autoimmune retinopathy, nodular scleritis, posterior scleritis, and optic neuritis. Five patients had an acute course and nine suffered from chronic disease. Eleven patients were on anti-inflammatory medication upon their presentation. The average time to presentation to uveitis clinic was 43.8 months (range one week to 20 years). All fourteen patients had positive combined herpes simplex virus (HSV) 1&2 IgM on presentation to uveitis clinic. All patients were started on antiviral therapy upon positive serology results. Eleven of the fourteen patients had no recurrence of inflammation after starting antiviral therapy. Two patients experienced recurrent inflammation after antiviral therapy was stopped and one patient suffered recurrent inflammation despite antiviral therapy. The mean length of follow-up was 14.6 months (range one to 39 months).
This cohort of patients with ocular inflammation recalcitrant to anti-inflammatory therapy and elevated HSV-IgM showed a timely clinical response to the addition of anti-herpes virus therapy. Since HSV may play a role (direct or indirect) in ocular inflammation and its replication may be promoted by standard anti-inflammatory therapies, routine testing of recalcitrant cases for HSV may be beneficial since its suppression may have a favorable effect on disease course.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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