EBV Induced Lymphoproliferation of the Iris after Heart Transplantation
Zierhut M., Rohrbach J. M.
University of Tuebingen, Department of Ophthalmology, Dep. I, Tuebingen
Purpose: Today various tumours are known to immitate uveitis ("Masquerade Syndromes"). The "polymorphic posttransplantation-lymphoproliferative Disease (PTLD)" also belongs to this group.
Case Report: A seven-year-old boy developed a steroid resistant anterior uveitis with iris mass in both eyes. Because of heart transplantation 4 years ago he permanently was under immunosuppression. Secondary angle closure glaucoma necessitated a diagnostic and therapeutic iridectomy. Morphological investigation of the specimen disclosed a polymorphic posttransplantation lymphoproliferative disorder. Besides the presence of Epstein-Barr virus in the iris, the EBV-load in peripheral blood monocytes was massively elevated, indicating a chronic EBV-infection. After conservative treatment and radiation therapy, the iris mass quickly resolved.
Conclusions: PTLD is a well known entity, rarely effecting the eye and leading to uveitis. Until today appr. 10 patients with iris involvement have been described. While antiviral treatment is ineffective, radiation treatment was successful. Because of the elevated viral load, the prognosis is very poor. For such situations, immunotherapies are under study which have already shown to be effective in some patients.
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