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Varicella-zoster viral antigen identified in iridocyclitis patient
Hiroyuki Nakashizuka1, Yoshio Yamazaki, Motoki Tokumaru
1Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan.
Background:
The varicella-zoster virus (VZV) antigen has not been identified immunohistologically in iridocyclitis due to VZV.
Case:
A 65-year-old woman diagnosed with iridocyclitis and secondary glaucoma underwent trabeculectomy. Samples of aqueous humor and juxtacanalicular and iris tissue were obtained for immunohistological and polymerase chain reaction (PCR) study.
Observations:
Slit-lamp microscopy revealed ciliary injection, corneal epithelial edema, mutton fat precipitates, flare, cells, and progressive iris atrophy in the right eye. Subsequently, scant eruptions on her right upper eyelid appeared and disappeared within a week. Although a diagnostic increase in the complement fixation antibody titer to VZV was not observed, we started medical treatment for VZV, on suspicion of iridocyclitis due to VZV. Despite medical treatment, the ratio of peripheral anterior synechia was greater than 60% and iris atrophy progressed in parallel. The intraocular pressure in the right eye remained above 30 mm Hg at 6 months after the first visit, so trabeculectomy was performed. VZV-specific DNA was detected in the aqueous humor by the PCR study. Immunohistological examination demonstrated numerous VZV antigen-positive cells in the iris stroma, in particular, vascular endothelial cells.
Conclusion:
To our knowledge, this is the first report of the detection of VZV antigen in the iris of an iridocyclitis patient.