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2015 Agenda and Abstracts | < Previous | Next >

2015 OMIG Abstract 5

Epstein-Barr Virus-Associated Scleritis Responsive to Valganciclovir:
A Case Report

Robert Garoon, M.D., Alice Matoba, M.D.
Cullen Eye Institute, Baylor College of Medicine

Purpose: To describe a case of Epstein-Barr virus (EBV)–associated scleritis responsive to valganciclovir.

Methods: A patient with EBV–associated scleritis was retrospectively reviewed.

Results: A 58 year old woman was referred with a 25 year history of recurrent bouts of bilateral episcleral and scleral inflammation. An evaluation by a rheumatologist had been negative. The inflammation had gradually become more persistent. At the time of referral she reported a 15 month bout of bilateral scleritis, poorly responsive to topical nepafenac, loteprednol, prednisolone, and oral ibuprofen and methylprednisolone. Slit lamp evaluation revealed bilateral diffuse scleral inflammation with moderate tenderness. There were no nodules, no areas of thinning, ulceration, or avascularity. The corneas were clear. CBC, HSV and VZV serologies were unremarkable. Antibody titer for EBV VCA was > 750 U/mL (nl <18), EBV nuclear antigen 512 U/mL (nl <18), EBV early antigen 77.8 U/mL (nl <9.0). Additional workup by a rheumatologist was again negative. The patient was treated with difluprednate QID and oral ibuprofen. The patient had a mild initial response but had rapid increase in inflammation upon taper of topical difluprednate.

After 3 months, the rheumatologist recommended therapy with azathioprine. Repeat EBV serologies revealed persistent elevation. Oral valganciclovir was initiated instead. Over the course of one month, there was marked improvement of scleritis, allowing taper of topical steroid. The patient also reported significant improvement of chronic severe fatigue.

Conclusion: To our knowledge, this is the first case of EBV-associated scleritis which demonstrated a response to antiviral therapy. This case supports the hypothesis that EBV is a cause of scleritis.


2015 Agenda and Abstracts | < Previous | Next >