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Journal of Ophthalmic Inflammation and Infection

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Open Access 01-12-2014 | Brief report

A case of bilateral human herpes virus 6 panuveitis with genomic viral DNA integration

Authors: Jasmina Bajric, Wendy M Smith

Published in: Journal of Ophthalmic Inflammation and Infection | Issue 1/2014

Abstract

Background

We report a rare case of bilateral panuveitis from human herpes virus 6 (HHV-6) with genomic viral DNA integration in an immunocompromised man.

Findings

A 59-year-old man with history of multiple myeloma presented with altered mental status, bilateral eye redness, and blurry vision. Examination revealed bilateral diffuse keratic precipitates, 4+ anterior chamber cell, hypopyon, vitritis, and intraretinal hemorrhages. Intraocular fluid testing by polymerase chain reaction (PCR) was positive for HHV-6. The patient was successfully treated with intravitreal foscarnet and intravenous ganciclovir and foscarnet. Despite clinical improvement, his serum HHV-6 levels remained high, and it was concluded that he had HHV-6 chromosomal integration.

Conclusions

HHV-6 should be considered in the differential for infectious uveitis in immunocompromised hosts who may otherwise have a negative work-up. HHV-6 DNA integration may lead to difficulties in disease diagnosis and determining disease resolution.

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Razonable RR: Human herpes viruses 6, 7 and 8 in solid organ transplant recipients. Am J Trp 2013, 13: 67–78. 10.1111/ajt.12008CrossRef

Takizawa Y, Hayashi S, Fujimaki T, Mizota A, Yokoyama T, Tanaka M, Murakami A: Central retinal vein occlusion caused by human herpes virus 6. J Pediatr Ophthalmol Strabismus 2006, 43: 176–178.PubMed

Oberacher-Velten IM, Jonas JB, Junemann A, Schmidt B: Bilateral optic neuropathy and unilateral tonic pupil associated with acute human herpes virus 6 infection: a case report. Graefes Arch Clin Exp Ophthalmol 2005, 243: 175–177. 10.1007/s00417-004-0986-8CrossRefPubMed

Okuno T, Hooper LC, Ursea R, Smith J, Nussenblatt R, Hooks JJ, Hayashi K: Role of human herpes virus 6 in corneal inflammation alone or with human herpes viruses. Cornea 2011, 30: 204–207. 10.1097/ICO.0b013e3181e2e9beCrossRefPubMed

Maslin J, Bigaillon C, Froussard F, Enouf V, Nicand E: Acute bilateral uveitis associated with an active human herpes virus-6 infection. J Infect 2007, 54: e237-e240. 10.1016/j.jinf.2006.12.012CrossRefPubMed

De Groot-Mijnes JD, de Visser L, Zuurveen S, Martinus RA, Volker R, ten Dam-van Loon NH, de Boer JH, Postma G, de Groot RJ, van Loon AM, Rothova A: Identification of new pathogens in the intraocular fluid of patients with uveitis. Am J Ophthalmol 2010, 150: 628–636. 10.1016/j.ajo.2010.05.015CrossRefPubMed

Sugita S, Shimizu N, Kawaguchi T, Akao N, Morio T, Mochizuki M: Identification of human herpes virus 6 in a patient with severe unilateral panuveitis. Arch Ophthalmol 2007, 125: 1426–1427. 10.1001/archopht.125.10.1426CrossRefPubMed

Malamos P, Maselos S, Andrianopoulos K, Georgalas I, Chryssos G, Markomichelakis NN: Human herpes virus-6 as a cause of recurrent posterior uveitis in a HIV-positive patient. Retin Cases Brief Rep 2013, 7: 131–133. 10.1097/ICB.0b013e3182595705CrossRefPubMed

Caserta MT: Human herpes virus 6 infection of the central nervous system. Curr Infect Dis Rep 2004, 6: 316–321. 10.1007/s11908-004-0054-xCrossRefPubMed

10.

Hall CB, Long CE, Schnabel KC, Caserta MT, McIntyre KM, Costanzo MA, Knott A, Dewhurst S, Insel RA, Epstein LG: Human herpes virus-6 infection in children a prospective study of complications and reactivation. N Engl J Med 1994, 331: 432–438. 10.1056/NEJM199408183310703CrossRefPubMed

11.

Morissette G, Flamand L: Herpes viruses and chromosomal integration. J Virol 2010, 84: 12100–12109. 10.1128/JVI.01169-10PubMedCentralCrossRefPubMed

12.

Pellett PE, Ablashi DV, Ambros PF, Agut H, Caserta MT, Descamps V, Flamand L, Gautheret-Dejean A, Hall CB, Kamble RT, Kuehl U, Lassner D, Lautenschlager I, Loomis KS, Luppi M, Lusso P, Medveczky PG, Montoya JG, Mori Y, Ogata M, Pritchett JC, Rogez S, Seto E, Ward KN, Yoshikawa T, Razonable RR: Chromosomally integrated human herpes virus 6: questions and answers. Rev Med Virol 2012, 22: 144–155. 10.1002/rmv.715PubMedCentralCrossRefPubMed

Title: A case of bilateral human herpes virus 6 panuveitis with genomic viral DNA integration
Authors: Jasmina Bajric
Wendy M Smith
Publication date: 01-12-2014
Publisher: Springer Berlin Heidelberg
Published in: Journal of Ophthalmic Inflammation and Infection / Issue 1/2014
Electronic ISSN: 1869-5760
DOI: https://doi.org/10.1186/s12348-014-0016-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

A case of bilateral human herpes virus 6 panuveitis with genomic viral DNA integration

Abstract

Background

Findings

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Findings

Conclusions

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