Open AccessSuccessful Treatment of Epstein-Barr Virus-Induced Necrotizing Retinitis with Intravitreous Ganciclovir, Foscarnet, and Methotrexate
Author(s) -
Cho Junsang,
Bhavsar Abdhish R.,
Cho Daniel H.,
Sattarova Victoria,
Abel Anne S.,
Zadroga Rebecca
Publication year - 2022
Publication title -
case reports in ophthalmology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.299
H-Index - 17
ISSN - 1663-2699
DOI - 10.1159/000520408
Subject(s) - case report
This is a report of an immunocompromised 49-year-old renal transplant patient with Epstein-Barr virus (EBV)-induced necrotizing retinitis (NR). The patient with NR underwent diagnostic vitrectomy. Polymerase chain reaction (PCR) testing of the vitreous fluid was positive for EBV (25,000 IU/mL) and negative for all other organisms. The patient was treated with intravitreous ganciclovir and foscarnet. After only mild clinical improvement in retinitis and an increased quantitative EBV PCR (69,000 IU/mL), intravitreous methotrexate was added to the aforementioned intravitreous antiviral injections. After eight rounds of ganciclovir/foscarnet and three injections of methotrexate, the NR resolved, the quantitative EBV PCR decreased to 29 IU/mL, and the patient’s visual acuity improved. To our knowledge, this is only the second case report to demonstrate efficacy of intravitreous methotrexate in an immunocompromised patient with EBV-induced NR. Intravitreous methotrexate combined with ganciclovir and foscarnet may be an effective treatment strategy for patients with PCR-positive EBV-induced NR that does not respond to conventional antiviral therapy.