Cytomegalovirus as a possibly overlooked agent of hypertensive anterior uveitis and endotheliitis in immunocompetent patients in Brazil
ABSTRACT Cytomegalovirus (CMV) is a member of the Herpesviridae family, including viruses that are well-known agents of keratitis, anterior uveitis, scleritis and retinitis. CMV is usually associated with ocular diseases in immunosuppressed individuals, with a notable exception of hypertensive anter...
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Universidade de São Paulo (USP)
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ftdoajarticles:oai:doaj.org/article:a9b684fc4f6c4501b1bbd82ee61d9963 2024-09-09T19:26:36+00:00 Cytomegalovirus as a possibly overlooked agent of hypertensive anterior uveitis and endotheliitis in immunocompetent patients in Brazil Caroline dos Reis Bruno Avelar Miranda Aloysio Fellet da Cunha Afonso Leandro H. Malta e Cunha Bruno Cançado Trindade Daniel Vitor Vasconcelos-Santos 2021-12-01T00:00:00Z https://doi.org/10.1590/s1678-9946202163084 https://doaj.org/article/a9b684fc4f6c4501b1bbd82ee61d9963 EN eng Universidade de São Paulo (USP) http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652021000100515&tlng=en https://doaj.org/toc/1678-9946 1678-9946 doi:10.1590/s1678-9946202163084 https://doaj.org/article/a9b684fc4f6c4501b1bbd82ee61d9963 Revista do Instituto de Medicina Tropical de São Paulo, Vol 63 (2021) Cytomegalovirus Anterior uveitis Glaucomatocyclitic crisis Hypertensive anterior uveitis Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 article 2021 ftdoajarticles https://doi.org/10.1590/s1678-9946202163084 2024-08-05T17:49:30Z ABSTRACT Cytomegalovirus (CMV) is a member of the Herpesviridae family, including viruses that are well-known agents of keratitis, anterior uveitis, scleritis and retinitis. CMV is usually associated with ocular diseases in immunosuppressed individuals, with a notable exception of hypertensive anterior uveitis with distinctive clinical features in immunocompetent patients. This syndrome was characterized in the last two decades in Europe and Southeast Asia, and then documented in the rest of world. Definitive diagnosis in these cases is usually made by Polymerase Chain Reaction (PCR) of the anterior chamber fluid. We report three immunocompetent Brazilian adults with history of multiple glaucomatocyclitic crises and presenting with chronic hypertensive anterior uveitis invariably with mild anterior chamber inflammation and characteristic scarce nummular keratic precipitates. CMV DNA was successfully amplified and detected in the aqueous humor of all patients. Corneal endothelial counts were significantly reduced in the involved eyes, with one patient developing bullous keratopathy. All patients were then treated with topical ganciclovir gel and corticosteroids, with subsequent control of the intraocular inflammation. CMV may represent an overlooked / underestimated etiology of hypertensive anterior uveitis that may progressively lead to endothelial dysfunction, culminating in bullous keratopathy. Management of patients is challenging, with the potential use of topical antivirals to decrease the number of relapses, and corticosteroids to control anterior uveitis / endotheliitis and to protect the corneal endothelium. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic Revista do Instituto de Medicina Tropical de São Paulo 63 |
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Directory of Open Access Journals: DOAJ Articles |
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ftdoajarticles |
language |
English |
topic |
Cytomegalovirus Anterior uveitis Glaucomatocyclitic crisis Hypertensive anterior uveitis Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 |
spellingShingle |
Cytomegalovirus Anterior uveitis Glaucomatocyclitic crisis Hypertensive anterior uveitis Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 Caroline dos Reis Bruno Avelar Miranda Aloysio Fellet da Cunha Afonso Leandro H. Malta e Cunha Bruno Cançado Trindade Daniel Vitor Vasconcelos-Santos Cytomegalovirus as a possibly overlooked agent of hypertensive anterior uveitis and endotheliitis in immunocompetent patients in Brazil |
topic_facet |
Cytomegalovirus Anterior uveitis Glaucomatocyclitic crisis Hypertensive anterior uveitis Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 |
description |
ABSTRACT Cytomegalovirus (CMV) is a member of the Herpesviridae family, including viruses that are well-known agents of keratitis, anterior uveitis, scleritis and retinitis. CMV is usually associated with ocular diseases in immunosuppressed individuals, with a notable exception of hypertensive anterior uveitis with distinctive clinical features in immunocompetent patients. This syndrome was characterized in the last two decades in Europe and Southeast Asia, and then documented in the rest of world. Definitive diagnosis in these cases is usually made by Polymerase Chain Reaction (PCR) of the anterior chamber fluid. We report three immunocompetent Brazilian adults with history of multiple glaucomatocyclitic crises and presenting with chronic hypertensive anterior uveitis invariably with mild anterior chamber inflammation and characteristic scarce nummular keratic precipitates. CMV DNA was successfully amplified and detected in the aqueous humor of all patients. Corneal endothelial counts were significantly reduced in the involved eyes, with one patient developing bullous keratopathy. All patients were then treated with topical ganciclovir gel and corticosteroids, with subsequent control of the intraocular inflammation. CMV may represent an overlooked / underestimated etiology of hypertensive anterior uveitis that may progressively lead to endothelial dysfunction, culminating in bullous keratopathy. Management of patients is challenging, with the potential use of topical antivirals to decrease the number of relapses, and corticosteroids to control anterior uveitis / endotheliitis and to protect the corneal endothelium. |
format |
Article in Journal/Newspaper |
author |
Caroline dos Reis Bruno Avelar Miranda Aloysio Fellet da Cunha Afonso Leandro H. Malta e Cunha Bruno Cançado Trindade Daniel Vitor Vasconcelos-Santos |
author_facet |
Caroline dos Reis Bruno Avelar Miranda Aloysio Fellet da Cunha Afonso Leandro H. Malta e Cunha Bruno Cançado Trindade Daniel Vitor Vasconcelos-Santos |
author_sort |
Caroline dos Reis |
title |
Cytomegalovirus as a possibly overlooked agent of hypertensive anterior uveitis and endotheliitis in immunocompetent patients in Brazil |
title_short |
Cytomegalovirus as a possibly overlooked agent of hypertensive anterior uveitis and endotheliitis in immunocompetent patients in Brazil |
title_full |
Cytomegalovirus as a possibly overlooked agent of hypertensive anterior uveitis and endotheliitis in immunocompetent patients in Brazil |
title_fullStr |
Cytomegalovirus as a possibly overlooked agent of hypertensive anterior uveitis and endotheliitis in immunocompetent patients in Brazil |
title_full_unstemmed |
Cytomegalovirus as a possibly overlooked agent of hypertensive anterior uveitis and endotheliitis in immunocompetent patients in Brazil |
title_sort |
cytomegalovirus as a possibly overlooked agent of hypertensive anterior uveitis and endotheliitis in immunocompetent patients in brazil |
publisher |
Universidade de São Paulo (USP) |
publishDate |
2021 |
url |
https://doi.org/10.1590/s1678-9946202163084 https://doaj.org/article/a9b684fc4f6c4501b1bbd82ee61d9963 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
Revista do Instituto de Medicina Tropical de São Paulo, Vol 63 (2021) |
op_relation |
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652021000100515&tlng=en https://doaj.org/toc/1678-9946 1678-9946 doi:10.1590/s1678-9946202163084 https://doaj.org/article/a9b684fc4f6c4501b1bbd82ee61d9963 |
op_doi |
https://doi.org/10.1590/s1678-9946202163084 |
container_title |
Revista do Instituto de Medicina Tropical de São Paulo |
container_volume |
63 |
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