Epstein-Barr Virus Corneal Endotheliitis and Uveitis in a Patient With Extranodal Natural Killer/T-Cell Lymphoma

To report a case of Epstein-Barr virus (EBV) corneal endotheliitis and uveitis in a patient diagnosed with extranodal natural killer/T-cell lymphoma (ENKTL).

This is a case report performed at a tertiary care center in the Republic of Korea.

A 64-year-old man presented with decreased vision in his right eye that had persisted for 4 days. Best-corrected visual acuity was finger counting at 50 cm in the right eye and 0.8 in the left eye. Intraocular pressure was within the normal range in both eyes. Slit-lamp examination revealed scattered keratic precipitations and diffuse corneal edema in the right eye. Because of the severe edema, anterior chamber (AC) details were obscured. In the left eye, +2 inflammatory cells were observed in the AC and +1 cells in the vitreous. A multiplex polymerase chain reaction test using aqueous humor samples from each eye yielded positive results for EBV but negative results for other herpes viruses. One week after initiating treatment with a topical acyclovir ointment, topical steroids, and oral acyclovir, corneal edema and AC inflammation improved. Subsequently, the patient was diagnosed with nasal ENKTL and underwent 3 chemotherapy cycles in the hematology-oncology department. Five months after commencing topical and oral antiviral therapies, best-corrected visual acuities improved to 0.5 in the right eye and 1.0 in the left eye.

EBV infection can cause severe corneal edema and uveitis. In patients with ENKTL, EBV should be considered a possible etiology of ocular involvement, and timely ophthalmic management may contribute to better visual outcomes.