Epstein-Barr Virus Associated Frosted Branch Angiitis.

Abstract

Purpose: To describe two cases of frosted branch angiitis (FBA) in the setting of Epstein-Barr virus (EBV) infection.

Methods: Retrospective case series of two patients at the University of Colorado Sue Anschutz-Rodgers Eye Center.

Results: Case 1 is a 17-year-old female who presented with bilateral floaters and blurry vision two weeks after a diagnosis of mononucleosis. Visual acuity was 20/20 in both eyes and exam was significant for vitreous cell and FBA appearance to the retinal vasculature in both eyes. Treatment with oral prednisone and valacyclovir was initiated with improvement in vitritis and vascular sheathing. One month after all treatment was discontinued, there was a recurrence of vitritis that was treated with bilateral sub-Tenon's triamcinolone acetonide injections. Final visual acuity was 20/20 in both eyes with resolved vitritis. Case 2 is a 20-year-old male who presented with headache and acute bilateral vision loss. He was found to have a meningoencephalitis with cerebrospinal fluid positive for EBV that was treated with intravenous methylprednisolone and acyclovir. Visual acuity was count fingers in both eyes. Exam was significant for diffuse bilateral frosted branch angiitis which the subsequent development of bilateral bacillary detachments and neuroretinitis that required treatment with oral prednisone, oral acyclovir, and bilateral intravitreal dexamethasone implants, which resolved all ocular inflammation. Final visual acuity was 20/30 right eye and 20/25 left eye.

Conclusion: Bilateral FBA may present following EBV infection and responds well to corticosteroids and antiviral therapy.