Successful Treatment of Necrotizing Retinitis with Epstein–Barr Virus-Positive Ocular Fluid by Intravitreal Methotrexate Injection

ABSTRACT

Purpose

To present a case of necrotizing retinitis with Epstein–Barr virus (EBV)-positive ocular fluid in a patient with sudden unilateral vision loss, which was successfully treated with intravitreal methotrexate (MTX) injections.

Methods

Retrospective case report.

Results

An 83-year-old female who had been on methylprednisolone for 20 years due to interstitial pneumonia developed vitreous opacity and extensive necrotizing retinitis with retinal hemorrhage sparing the posterior pole in the left eye. Multiplex polymerase chain reaction (PCR) for viral DNA using vitreous sample was positive for EBV but negative for herpes simplex virus, varicella-zoster virus, and cytomegalovirus. Real-time PCR detected EBV-DNA in aqueous humor but not in peripheral blood sample. Serologic testing was negative for Toxoplasma gondii, syphilis, and HIV. The patient did not respond to systemic ganciclovir or acyclovir. Subsequent treatment with intravitreal MTX resulted in immediate clinical improvement correlating with a decrease in copy number of EBV-DNA.

Conclusion

Intravitreal MTX may be an effective treatment option for patients with necrotizing retinitis and EBV-positive ocular fluid not responding to conventional antiviral therapy.

Keywords:

• Epstein–Barr
• virus
• intravitreal
• methotrexate
• injection
• necrotizing retinitis

Declaration of interest

The authors report no conflicts of interest.

Acknowledgments

This work was supported by a Grand-in-Aid for Scientific Research (C) 16K11330 from the Ministry of Education, Culture, Sports, Science and Technology of Japan.

Additional information

Funding

This work was supported by the Ministry of Education, Culture, Sports, Science and Technology of Japan [16K11330].