Cytomegalovirus as a possibly overlooked agent of hypertensive anterior uveitis and endotheliitis in immunocompetent patients in Brazil
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Outros Autores: | , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UFMG |
Texto Completo: | https://doi.org/10.1590/S1678-9946202163084 http://hdl.handle.net/1843/54968 https://orcid.org/0000-0002-1733-6008 https://orcid.org/0000-0002-6453-2167 https://orcid.org/0000-0002-6747-2024 |
Resumo: | 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. |
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2023-06-15T21:18:55Z2023-06-15T21:18:55Z202163https://doi.org/10.1590/S1678-99462021630841678-9946http://hdl.handle.net/1843/54968https://orcid.org/0000-0002-1733-6008https://orcid.org/0000-0002-6453-2167https://orcid.org/0000-0002-6747-2024Cytomegalovirus (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.O citomegalovírus (CMV) é um membro da família Herpesviridae, incluindo vírus que são agentes bem conhecidos de ceratite, uveíte anterior, esclerite e retinite. O CMV geralmente está associado a doenças oculares em indivíduos imunossuprimidos, com exceção notável da uveíte anterior hipertensiva com características clínicas distintas em pacientes imunocompetentes. Essa síndrome foi caracterizada nas últimas duas décadas na Europa e no Sudeste Asiático e depois documentada no resto do mundo. O diagnóstico definitivo nesses casos costuma ser feito pela Reação em Cadeia da Polimerase (PCR) do líquido da câmara anterior. Relatamos três adultos brasileiros imunocompetentes com história de múltiplas crises glaucomatociclíticas e apresentando uveíte anterior hipertensiva crônica invariavelmente com leve inflamação da câmara anterior e escassos precipitados ceráticos numulares característicos. O DNA do CMV foi amplificado com sucesso e detectado no humor aquoso de todos os pacientes. As contagens endoteliais da córnea foram significativamente reduzidas nos olhos envolvidos, com um paciente desenvolvendo ceratopatia bolhosa. Todos os pacientes foram então tratados com ganciclovir gel tópico e corticosteroides, com posterior controle da inflamação intraocular. O CMV pode representar uma etiologia negligenciada/subestimada da uveíte anterior hipertensiva que pode levar progressivamente à disfunção endotelial, culminando em ceratopatia violenta. O manejo dos pacientes é desafiador, com o uso potencial de antivirais tópicos para diminuir o número de recidivas e corticosteróides para controlar uveíte anterior/endotelite e proteger o endotélio corneano.engUniversidade Federal de Minas GeraisUFMGBrasilHCL - HOSPITAL DAS CLINICASMED - DEPARTAMENTO DE OFTALMOLOGIA E OTORRINOLARINGOLOGIARevista do Instituto de Medicina Tropical de São PauloOftalmologiaCitomegalovirusUveíte anteriorCytomegalovirusAnterior uveitisGlaucomatocyclitic crisisHypertensive anterior uveitisCytomegalovirus as a possibly overlooked agent of hypertensive anterior uveitis and endotheliitis in immunocompetent patients in BrazilCitomegalovírus como um agente possivelmente negligenciado de uveíte anterior hipertensiva e endotelite em pacientes imunocompetentes no Brasilinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttps://www.scielo.br/j/rimtsp/a/zqDK75GjWxJq99XPh4sM8hk/?lang=enCaroline dos ReisBruno Avelar MirandaAloysio Fellet da Cunha AfonsoLeandro Henrique Malta e CunhaBruno Lovaglio Cançado TrindadeDaniel Vítor de Vasconcelos Santosapplication/pdfinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGLICENSELicense.txtLicense.txttext/plain; charset=utf-82042https://repositorio.ufmg.br/bitstream/1843/54968/1/License.txtfa505098d172de0bc8864fc1287ffe22MD51ORIGINALCytomegalovirus as a possibly overlooked agent of hypertensive anterior uveitis and endotheliitis in immunocompetent patients in Brazil.pdfCytomegalovirus as a possibly overlooked agent of hypertensive anterior uveitis and endotheliitis in immunocompetent patients in Brazil.pdfapplication/pdf666985https://repositorio.ufmg.br/bitstream/1843/54968/2/Cytomegalovirus%20as%20a%20possibly%20overlooked%20agent%20of%20hypertensive%20anterior%20uveitis%20and%20endotheliitis%20in%20immunocompetent%20patients%20in%20Brazil.pdfc4e267deb7acb4defaa0526ad97c9663MD521843/549682023-06-15 18:18:55.624oai:repositorio.ufmg.br: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Repositório de PublicaçõesPUBhttps://repositorio.ufmg.br/oaiopendoar:2023-06-15T21:18:55Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false |
dc.title.pt_BR.fl_str_mv |
Cytomegalovirus as a possibly overlooked agent of hypertensive anterior uveitis and endotheliitis in immunocompetent patients in Brazil |
dc.title.alternative.pt_BR.fl_str_mv |
Citomegalovírus como um agente possivelmente negligenciado de uveíte anterior hipertensiva e endotelite em pacientes imunocompetentes no Brasil |
title |
Cytomegalovirus as a possibly overlooked agent of hypertensive anterior uveitis and endotheliitis in immunocompetent patients in Brazil |
spellingShingle |
Cytomegalovirus as a possibly overlooked agent of hypertensive anterior uveitis and endotheliitis in immunocompetent patients in Brazil Caroline dos Reis Cytomegalovirus Anterior uveitis Glaucomatocyclitic crisis Hypertensive anterior uveitis Oftalmologia Citomegalovirus Uveíte anterior |
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 |
author |
Caroline dos Reis |
author_facet |
Caroline dos Reis Bruno Avelar Miranda Aloysio Fellet da Cunha Afonso Leandro Henrique Malta e Cunha Bruno Lovaglio Cançado Trindade Daniel Vítor de Vasconcelos Santos |
author_role |
author |
author2 |
Bruno Avelar Miranda Aloysio Fellet da Cunha Afonso Leandro Henrique Malta e Cunha Bruno Lovaglio Cançado Trindade Daniel Vítor de Vasconcelos Santos |
author2_role |
author author author author author |
dc.contributor.author.fl_str_mv |
Caroline dos Reis Bruno Avelar Miranda Aloysio Fellet da Cunha Afonso Leandro Henrique Malta e Cunha Bruno Lovaglio Cançado Trindade Daniel Vítor de Vasconcelos Santos |
dc.subject.por.fl_str_mv |
Cytomegalovirus Anterior uveitis Glaucomatocyclitic crisis Hypertensive anterior uveitis |
topic |
Cytomegalovirus Anterior uveitis Glaucomatocyclitic crisis Hypertensive anterior uveitis Oftalmologia Citomegalovirus Uveíte anterior |
dc.subject.other.pt_BR.fl_str_mv |
Oftalmologia Citomegalovirus Uveíte anterior |
description |
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. |
publishDate |
2021 |
dc.date.issued.fl_str_mv |
2021 |
dc.date.accessioned.fl_str_mv |
2023-06-15T21:18:55Z |
dc.date.available.fl_str_mv |
2023-06-15T21:18:55Z |
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info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/article |
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article |
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dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/1843/54968 |
dc.identifier.doi.pt_BR.fl_str_mv |
https://doi.org/10.1590/S1678-9946202163084 |
dc.identifier.issn.pt_BR.fl_str_mv |
1678-9946 |
dc.identifier.orcid.pt_BR.fl_str_mv |
https://orcid.org/0000-0002-1733-6008 https://orcid.org/0000-0002-6453-2167 https://orcid.org/0000-0002-6747-2024 |
url |
https://doi.org/10.1590/S1678-9946202163084 http://hdl.handle.net/1843/54968 https://orcid.org/0000-0002-1733-6008 https://orcid.org/0000-0002-6453-2167 https://orcid.org/0000-0002-6747-2024 |
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1678-9946 |
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eng |
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eng |
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Revista do Instituto de Medicina Tropical de São Paulo |
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openAccess |
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Universidade Federal de Minas Gerais |
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UFMG |
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Brasil |
dc.publisher.department.fl_str_mv |
HCL - HOSPITAL DAS CLINICAS MED - DEPARTAMENTO DE OFTALMOLOGIA E OTORRINOLARINGOLOGIA |
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Universidade Federal de Minas Gerais |
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