PCR-Confirmed Bilateral Varicella Zoster Virus Anterior Uveitis in an Immunosuppressed Young Adult

To describe a rare, PCR-confirmed case of bilateral fibrinous anterior uveitis with hypopyon after primary varicella infection in an immunosuppressed adult, highlighting the value of early testing and antiviral therapy for vision preservation.

A 24-year-old man, immunosuppressed after bone marrow transplantation for acute myeloblastic leukemia, developed pain, redness, and blurred vision in the left eye two weeks after systemic varicella; the right eye became involved three days later. Both eyes had fibrinous anterior uveitis with hypopyon, elevated intraocular pressure, and early patchy iris atrophy. Aqueous humor real-time PCR confirmed varicella-zoster virus and excluded herpes simplex virus and cytomegalovirus.

Best-corrected visual acuity improved from 20/150 to 20/25 in both eyes. Treatment included intravenous acyclovir for 10 days, intensive topical corticosteroids, cycloplegics, and temporary topical antiglaucoma therapy, followed by oral valacyclovir tapered from 1000 mg twice daily to 500 mg twice daily over eight weeks and continued for six months. Inflammation resolved, intraocular pressures normalized, and bilateral patchy iris atrophy persisted. Fundus examinations remained normal, with no retinal lesions or optic nerve abnormalities on serial examinations.

Sequential bilateral varicella-zoster virus anterior uveitis in adults is exceedingly rare and usually associated with systemic immunosuppression. PCR confirmation, together with elevated intraocular pressure and iris atrophy, supports the diagnosis and underscores the value of early molecular testing. Prompt systemic antiviral therapy with vigilant control of inflammation and intraocular pressure is essential to preserve vision. Long-term follow-up is crucial to detect intraocular pressure elevation or recurrence at an early stage.