Epstein-Barr virus-associated retinitis: a case report

To report the clinical features, diagnostic workup, and management of Epstein-Barr virus (EBV)-associated retinitis in a patient without overt clinical evidence of severe immunodeficiency.

A 33-year-old Chinese man presented with a 1-month history of blurred vision, redness, and photophobia in the left eye. Ocular examination revealed vitritis, white snowball-like vitreous deposits, optic disc edema, yellow-white retinal lesions, and tortuous retinal veins. Optical coherence tomography and fluorescein angiography supported active posterior segment inflammation. Initial vitreous smear and bacterial and fungal cultures were negative. Polymerase chain reaction testing of a vitreous sample detected EBV DNA at 123 copies/mL, whereas herpes simplex virus (HSV), varicella-zoster virus (VZV), and cytomegalovirus (CMV) were negative. The patient received systemic acyclovir combined with corticosteroid therapy. Intraocular inflammation improved markedly, but pars plana vitrectomy was later performed because of persistent organized vitreous opacity and retinal traction. At the 4-month follow-up, retinal lesions had largely resolved and best-corrected visual acuity improved to 0.2.

This case suggests that EBV should be considered in the differential diagnosis of atypical infectious retinitis. Vitreous PCR may provide important etiological evidence, and timely combined medical and surgical management may contribute to a favorable outcome.