Silpa-archa S, Rangseechamrat N, Sriyuttagrai W. Recalcitrant infectious uveoscleritis: A case report of a coinfection by Epstein-Barr virus and Talaromyces marneffei.
Ann Med Surg (Lond) 2022;
80:104283. [PMID:
36045833 PMCID:
PMC9422309 DOI:
10.1016/j.amsu.2022.104283]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction and importance
In an immunocompromised patient, there has never been a report of Epstein-Barr virus (EBV) and Talaromyces marneffei co-infection. Treatment with intravenous ganciclovir for EBV-associated uveitis has only been explored in a few cases.
Case presentation
A 47-year-old HIV-positive female presented with scleral nodule and vascularized iris tumor in the left eye. After the ancillary laboratory workup, EBV was detected by polymerase chain reaction on aqueous humor and scleral tissue analysis. The lesion subsided completely with systemic and local ganciclovir therapy. Subsequently, recurrent scleral nodule with iris plaque developed and was pathologically diagnosed as Talaromyces marneffei. The employed treatment, including intravenous amphotericin B and intracameral amphotericin B injection, was successful in attaining a significant regression of the lesion.
Clinical discussion
Although EBV treatment is debatable, our combination of systemic and local ganciclovir therapy demonstrated regression of EBV-caused scleral nodule and iris plaque. The organism's identification was complicated by Talaromyces marneffei, but it was easily treated.
Conclusions
In HIV-infected patients, EBV-associated sclerouveitis can be successfully treated with systemic and local ganciclovir therapy, and there is a possibility of coinfection with Talaromyces marneffei.
EBV can co-exist with Talaromyces marneffei causing severe sclerouveitis.
EBV-associated sclerouveitis can be successfully treated with ganciclovir therapy.
Sclerouveitis in an immunocompromised patient can be disastrous due to its progressive course and visual deterioration.
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