Acute bilateral uveitis associated with an active human herpesvirus-6 infection

Human herpesvirus 6 (HHV-6), which is usually responsible for exanthem subitum in children, can reactivate from its latent form after primary infection. It has been implicated in hepatitis, pneumonitis, retinitis and severe infections of the central nervous system in both immunosuppressed and immunocompetent patients. However, involvement of HHV-6 in these infections has not yet been clearly demonstrated. We report the case of a patient presenting a bilateral uveitis from whom HHV-6 was isolated in both aqueous fluid and cerebrospinal fluid (CSF). No other pathogenic agents were found. Diagnosis by polymerase chain reaction (PCR) followed by sequencing of part of the genome revealed the presence of HHV-6 in both aqueous fluid and CSF. Serum IgM and IgG HHV-6 antibodies were significantly elevated in two successive examinations by immunofluorescence. Patient recovery following antiviral therapy suggested that a protocol based on foscarnet followed by ganciclovir was effective. HHV-6 may be responsible for uveo-meningitis. Diagnosis by PCR analysis is essential to identify HHV-6 and to initiate a specific antiviral therapy as fast as possible.