EPSTEIN-BARR VIRUS-ASSOCIATED FROSTED BRANCH ANGIITIS

To describe two cases of frosted branch angiitis in the setting of Epstein-Barr virus infection.

Retrospective case series of two patients at the University of Colorado Sue Anschutz-Rodgers Eye Center.

Case 1 is a 17-year-old female patient who presented with bilateral floaters and blurry vision 2 weeks after a diagnosis of mononucleosis. Visual acuity was 20/20 in both eyes and examination was significant for vitreous cell and frosted branch angiitis appearance to the retinal vasculature in both eyes. Treatment with oral prednisone and valacyclovir was initiated with improvement in vitritis and vascular sheathing. One month after all treatment was discontinued, there was a recurrence of vitritis that was treated with bilateral sub-Tenon triamcinolone acetonide injections. Final visual acuity was 20/20 in both eyes with resolved vitritis. Case 2 is a 20-year-old male patient who presented with headache and acute bilateral vision loss. He was found to have a meningoencephalitis with cerebrospinal fluid positive for Epstein-Barr virus that was treated with IV methylprednisolone and acyclovir. Visual acuity was count fingers in both eyes. Fundus examination revealed diffuse bilateral frosted branch angiitis which the subsequent development of bilateral bacillary detachments and neuroretinitis that required treatment with oral prednisone, oral acyclovir, and bilateral intravitreal dexamethasone implants, which resolved all ocular inflammation. Final visual acuity was 20/30 in the right eye and 20/25 in the left eye.

Bilateral frosted branch angiitis may present after Epstein-Barr virus infection and responds well to corticosteroids and antiviral therapy.