J Korean Ophthalmol Soc.  2019 Jul;60(7):706-711. 10.3341/jkos.2019.60.7.706.

Frosted Branch Angiitis Associated with Epstein-Barr Virus Infection

Affiliations
  • 1Department of Ophthalmology, Maryknoll Hospital, Busan, Korea. ddalkieco@gmail.com

Abstract

PURPOSE
To report a case of frosted branch angiitis (FBA) associated with Epstein-Barr virus (EBV) infection in a child. CASE SUMMARY: A 7-year-old boy presented with bilateral blurred vision. On ophthalmic examination, his best-corrected visual acuity was 20/25 in the right eye and 20/32 in the left eye. The pupils were equal, round, and reactive to light without a relative afferent pupillary defect. He had normal color vision in both eyes. Slit-lamp examination revealed no abnormalities in the anterior parts of the eyes. Fundoscopic examination revealed prominent white sheathing retinal vasculitis predominantly on the veins in all quadrants, as well as macular edema and irregular foveal reflex in both eyes. Fluorescein angiography showed normal blood flow, but late diffuse staining and leakage of the affected vessels. Spectral domain optical coherence tomography (SD-OCT) showed thickening of the vessel walls, swelling due to hyperreflective material, and hyperreflective retinal depositions. Serological tests and the serum polymerase chain reaction for EBV were positive. A diagnosis of FBA associated with EBV was made. He was treated with systemic acyclovir and steroids. The response was rapid, with improvement in visual acuity to 20/20 in both eyes by day 3. After 7 weeks, all clinical signs resolved and SD-OCT examination showed normal vessel wall thickness and the absence of hyperreflective depositions.
CONCLUSIONS
EBV may present with FBA even in the absence of a systemic sign of primary EBV infection. Thus, EBV should be considered as the etiology of FBA.

Keyword

Epstein-Barr virus; Optical coherence tomography; Retinal vasculitis

MeSH Terms

Acyclovir
Child
Color Vision
Diagnosis
Epstein-Barr Virus Infections
Fluorescein Angiography
Herpesvirus 4, Human*
Humans
Macular Edema
Male
Polymerase Chain Reaction
Pupil
Pupil Disorders
Reflex
Retinal Vasculitis
Retinaldehyde
Serologic Tests
Steroids
Tomography, Optical Coherence
Vasculitis*
Veins
Visual Acuity
Acyclovir
Retinaldehyde
Steroids
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