Panuveitis by Coinfection with Toxoplasma gondii and Epstein Barr Virus. Should We Use Antiviral Therapy? – A Case Report

Laura Zarate-Pinzon; Luisa Fernanda Peña-Pulgar; Carlos Cifuentes-González; William Rojas-Carabali; María José Salgar; Alejandra de-la-Torre

doi:10.1080/09273948.2023.2182326

Panuveitis by Coinfection with Toxoplasma gondii and Epstein Barr Virus. Should We Use Antiviral Therapy? – A Case Report

Título traducido de la contribución: Panuveítis por Coinfección con Toxoplasma gondii y Virus de Epstein Barr. ¿Debemos utilizar terapia antiviral? - Informe de un caso

Laura Zarate-Pinzon, Luisa Fernanda Peña-Pulgar, Carlos Cifuentes-González, William Rojas-Carabali, María José Salgar, Alejandra de-la-Torre

Producción científica: Contribución a una revista › Carta › revisión exhaustiva

Resumen

Antecedentes: Comunicar la presentación atípica y el tratamiento en un caso de coinfección intraocular por Toxoplasma gondii (Tg) y virus de Epstein Barr (VEB). Presentación del caso: Paciente varón de 60 años que presentó una uveítis hipertensiva anterior seguida de un nuevo hallazgo de una lesión retinocoroidea esponjosa de color blanco amarillento en el cuadrante superior-temporal. Inicialmente fue tratado con terapia antiviral sin mejoría. A continuación, debido a la sospecha de infección por Tg, se añadió tratamiento antitoxoplásmico y se realizó vitrectomía terapéutica y diagnóstica junto con clindamicina intravítrea. El análisis de la reacción en cadena de la polimerasa (PCR) en los fluidos intraoculares confirmó la coinfección por Tg y VEB. Posteriormente, se administró tratamiento oral antitoxoplasma y antiviral y corticoides orales, consiguiéndose mejoría. Conclusiones: En un paciente con lesiones retinocoroideas atípicas se debe realizar una PCR de fluidos intraoculares, además de los laboratorios serológicos para descartar coinfección, confirmar el diagnóstico y establecer un tratamiento adecuado. La coinfección podría influir en la patogenia y el pronóstico de la enfermedad. Abreviaturas: OT: Toxoplasmosis ocular; Tg: Toxoplasma gondii; VEB: virus de Epstein Barr; CMV: citomegalovirus; VIH: virus de la inmunodeficiencia humana; VHS: virus del herpes simple; VVZ: virus de la varicela zóster; PCR: Reacción en cadena de la polimerasa; OD: ojo derecho; OS: Ojo izquierdo; BCVA: agudeza visual mejor corregida.

Título traducido de la contribución	Panuveítis por Coinfección con Toxoplasma gondii y Virus de Epstein Barr. ¿Debemos utilizar terapia antiviral? - Informe de un caso
Idioma original	Inglés estadounidense
Publicación	Ocular Immunology and Inflammation
DOI	https://doi.org/10.1080/09273948.2023.2182326
Estado	Publicada - mar. 9 2023

Áreas temáticas de ASJC Scopus

Inmulogía y alergología
Oftalmología

ODS de las Naciones Unidas

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title = "Panuveitis by Coinfection with Toxoplasma gondii and Epstein Barr Virus. Should We Use Antiviral Therapy? – A Case Report",

abstract = "Background: To report the atypical presentation and treatment in a case of Toxoplasma gondii (Tg) and Epstein Barr Virus (EBV) intraocular coinfection. Case Presentation: A 60-year-old male patient who presented anterior hypertensive uveitis followed by a new finding of a yellowish-white fluffy retinochoroidal lesion in the superior-temporal quadrant. He was initially treated with antiviral therapy without improvement. Next, due to the Tg infection suspicion, anti-toxoplasmic treatment was added, and therapeutic and diagnostic vitrectomy was performed along with intravitreal clindamycin. Polymerase chain reaction (PCR) analysis in intraocular fluids confirmed Tg and EBV coinfection. Then, anti-Toxoplasma oral treatment and antiviral and oral corticosteroids were administrated, achieving improvement. Conclusions: In a patient with atypical retinochoroidal lesions, an intraocular fluids PCR should be performed, in addition to the serological laboratories to rule out coinfection, confirm the diagnosis, and establish an appropriate treatment. Coinfection could impact the pathogenesis and prognosis of the disease. Abbreviations: OT: Ocular toxoplasmosis; Tg: Toxoplasma gondii; EBV: Epstein Barr Virus; CMV: Cytomegalovirus; HIV: Human Immunodeficiency Virus; HSV: Herpes Simplex Virus; VZV: Varicella Zoster Virus; PCR: Polymerase chain reaction; OD: Right eye; OS: Left eye; BCVA: best-corrected visual acuity.",

author = "Laura Zarate-Pinzon and Pe{\~n}a-Pulgar, {Luisa Fernanda} and Carlos Cifuentes-Gonz{\'a}lez and William Rojas-Carabali and Salgar, {Mar{\'i}a Jos{\'e}} and Alejandra de-la-Torre",

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T1 - Panuveitis by Coinfection with Toxoplasma gondii and Epstein Barr Virus. Should We Use Antiviral Therapy? – A Case Report

AU - Zarate-Pinzon, Laura

AU - Peña-Pulgar, Luisa Fernanda

AU - Cifuentes-González, Carlos

AU - Rojas-Carabali, William

AU - Salgar, María José

AU - de-la-Torre, Alejandra

PY - 2023/3/9

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N2 - Background: To report the atypical presentation and treatment in a case of Toxoplasma gondii (Tg) and Epstein Barr Virus (EBV) intraocular coinfection. Case Presentation: A 60-year-old male patient who presented anterior hypertensive uveitis followed by a new finding of a yellowish-white fluffy retinochoroidal lesion in the superior-temporal quadrant. He was initially treated with antiviral therapy without improvement. Next, due to the Tg infection suspicion, anti-toxoplasmic treatment was added, and therapeutic and diagnostic vitrectomy was performed along with intravitreal clindamycin. Polymerase chain reaction (PCR) analysis in intraocular fluids confirmed Tg and EBV coinfection. Then, anti-Toxoplasma oral treatment and antiviral and oral corticosteroids were administrated, achieving improvement. Conclusions: In a patient with atypical retinochoroidal lesions, an intraocular fluids PCR should be performed, in addition to the serological laboratories to rule out coinfection, confirm the diagnosis, and establish an appropriate treatment. Coinfection could impact the pathogenesis and prognosis of the disease. Abbreviations: OT: Ocular toxoplasmosis; Tg: Toxoplasma gondii; EBV: Epstein Barr Virus; CMV: Cytomegalovirus; HIV: Human Immunodeficiency Virus; HSV: Herpes Simplex Virus; VZV: Varicella Zoster Virus; PCR: Polymerase chain reaction; OD: Right eye; OS: Left eye; BCVA: best-corrected visual acuity.

AB - Background: To report the atypical presentation and treatment in a case of Toxoplasma gondii (Tg) and Epstein Barr Virus (EBV) intraocular coinfection. Case Presentation: A 60-year-old male patient who presented anterior hypertensive uveitis followed by a new finding of a yellowish-white fluffy retinochoroidal lesion in the superior-temporal quadrant. He was initially treated with antiviral therapy without improvement. Next, due to the Tg infection suspicion, anti-toxoplasmic treatment was added, and therapeutic and diagnostic vitrectomy was performed along with intravitreal clindamycin. Polymerase chain reaction (PCR) analysis in intraocular fluids confirmed Tg and EBV coinfection. Then, anti-Toxoplasma oral treatment and antiviral and oral corticosteroids were administrated, achieving improvement. Conclusions: In a patient with atypical retinochoroidal lesions, an intraocular fluids PCR should be performed, in addition to the serological laboratories to rule out coinfection, confirm the diagnosis, and establish an appropriate treatment. Coinfection could impact the pathogenesis and prognosis of the disease. Abbreviations: OT: Ocular toxoplasmosis; Tg: Toxoplasma gondii; EBV: Epstein Barr Virus; CMV: Cytomegalovirus; HIV: Human Immunodeficiency Virus; HSV: Herpes Simplex Virus; VZV: Varicella Zoster Virus; PCR: Polymerase chain reaction; OD: Right eye; OS: Left eye; BCVA: best-corrected visual acuity.

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Panuveitis by Coinfection with Toxoplasma gondii and Epstein Barr Virus. Should We Use Antiviral Therapy? – A Case Report

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