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Table 1 Summary of reported cases of intraocular inflammation associated with HHV-6 infection

From: Human Herpesvirus-6 corneal Endotheliitis after intravitreal injection of Ranibizumab

Author, year [reference umber]

Age (years)

Gender

Eye

DM

Other associated diseases

Ocular disease and complications

HHV-6 detection

Variant

Treatment

Clinical outcomes

aqueous humor

blood

Wiersbitzky, 1993 [18]

11

F

OS

–

None

Chronic iridocyclitis

NA

Anti-HHV-6 ab

 

NA

NA

Oberacher-Velten, 2005 [19]

31

M

OU

+

–

Optic neuropathy, unilateral tonic pupil

NA

Positive HHV-6 titers

 

Foscarnet, methylprednisolone

Optic nerve atrophy. Reaction of the pupil became normal. VA improved to 20/25 OD and 20/20 OS

Takizawa, 2006 [20]

1

F

OS

–

–

Central retinal vein occlusion by optic disc vasculitis

NA

+ HHV-6 DNA by PCR

 

Intravenous methylprednisolone

Optic disc atrophy, fundus atrophy. Unmeasurable VA

Moschettini, 2006 [21]

23

F

OU

–

None

Recurrent anterior optic neuritis and granulomatous iridocyclitis

NA

+ (also in CSF) by PCR

HHV-6B

Intravenous and oral glucocorticoids, Ganciclovir

Patient had optic neuritis 4 times. After last relapse, patient was successfully treated with ganciclovir.

Méchaï, 2007 [22]

59

F

OU

–

HIV

Retrobulbar optic neuritis and meningoencephalitis

NA

+ (also in CSF) by PCR

HHV-6B

Foscarnet and ganciclovir, then changed to cidofovir and long-term valganciclovir

By 12 months, the optic neuritis had almost resolved fully. VA was 20/20 (OU).

Sugita, 2007 [5]

75

M

OD

NA

Anti-Toxocara canis IgG in serum, aqueous humor, and vitreous

Severe panuveitis

+ (in also vitreous) by PCR

+ by PCR, Positive HHV-6 titer

HHV-6A

Diagnostic vitrectomy, valganciclovir, systemic corticosteroids

Resolution of vitreous opacities, disc swelling, and retinal exudates. HHV-6A DNA levels decreased in aqueous humor.

Maslin, 2007 [6]

81

M

OU

+

AML (in remission after chemotherapy)

Acute uveitis, disc edema Meningitis

+ by PCR

+ (in CSF) by PCR, Positive HHV-6 titer

HHV-6A

Foscarnet, ganciclovir

Disc edema was totally regressed. VA improved to the previous level of 20/40 (OD) and 20/32 (OS). HHV-6 was negative in aqueous humor and cerebrospinal fluid on day 45.

Cohen, 2010 [7]

NA

NA

NA

NA

Case 1; CMV retinitis

Case 1: Ocular inflammation

+ (in vitreous) by PCR Of 101 samples, Case 1 was positive for HHV-6A and CMV

NA

Case 1: HHV-6A

NA

NA

 

NA

NA

NA

NA

Case 2; none

Case 2: Ocular inflammation

+ (in vitreous) by PCR

NA

Case 2: HHV-6B

NA

NA

Groot-mijines, 2010 [23]

42

M

OD

–

–

Uveitis with heterochromia

+ (in vitreous) by PCR

NA

 

Diagnostic vitrectomy

Patient regained full VA

Glâtre F, 2010 [24]

47

F

Unilateral

–

RA, TB, Toxicoplasmic co-infection

panuveitis

+ by PCR

NA

 

Ganciclovir for HHV-6, and pyrimethamine and sulfadiazine for Toxicoplasma

NA

Ogata, 2011 [25]

63

M

OS

–

none

Uveitis with optic neuritis

+by PCR

Positive HHV-6 titer

 

Systemic corticosteroids, aspirin

VA improved to 10/20

Okuno T, 2011 [26]

N/A

N/A

NA

NA

HSV-1 was detected in 4 cases

Corneal ulcer in 6 cases and keratouveitis in 3 cases

+(in smear samples from corneal ulcer or keratouveitis) by PCR

NA

 

Acyclovir

NA

Sugita 2012 [8]

64

F

OS

NA

HSV-1

Corneal endotheliitis

+by PCR

N/A

HHV-6B

Valganciclovir

NA

70

M

OS

NA

bacteria (+)

Endophthalmitis, retinal necrosis

+ (in vitreous) by PCR

N/A

HHV-6B

Vitrectomy, antibiotics

NA

74

F

OD

NA

P. acnes

Postoperative endotheliitis

+(in vitreous) by PCR

N/A

HHV-6B

Vitrectomy, valganciclovir

NA

79

F

OS

NA

bacteria (+)

Postoperative endotheliitis

+(in vitreous) by PCR

N/A

HHV-6B

Vitrectomy, steroids, antibiotics

NA

71

F

OS

NA

CMV

Necrotic retinitis

+(in vitreous) by PCR

N/A

HHV-6A

Valganciclovir

NA

24

F

OS

NA

none

uveitis

+by PCR

N/A

HHV-6B

none

NA

22

M

OD

NA

bacteria (+)

keratitis

+(in cornea) by PCR

N/A

HHV-6B

Antibiotics

NA

Yokogawa, 2013 [27]

67

M

OD

–

RA CMV

Corneal endotheliitis

+ (Both HHV-6 and CMV) by PCR

NA

 

Valganciclovir, topical 0.5% ganciclovir 0.1% betamethasone

Corneal endotheliitis resolved VA improved to 20/25

Malamos, 2013 [28]

64

M

OU

–

HIV

Posterior uveitis

+ (in vitreous) by PCR

+ Positive HHV-6 titer

 

Diagnostic vitrectomy, valganciclovir

Complete remission of inflammation

Bajric, 2014 [29]

59

M

OU

–

Multiple myeloma

Panuveitis, encephalitis

Negative by PCR

+ (in CSF) by PCR

+ by PCR

Ganciclovir, foscarnet, intravitreal foscarnet

Encephalitis resolved. VA improved to 20/20 (OD) and 20/30 (OS) with complete resolution of retinal hemorrhages and no evidence of active uveitis.

Papageorgious, 2014 [9]

22

M

OU

–

EBV

Acute retinal necrosis, fourth nerve palsy, encephalitis

Not performed

+ (in CSF) by PCR

HHV-6A

Acyclovir, valacyclovir, methylprednisolone

VA improved to 20/20 (OU). There was no residual visual field defect, and binocular diplopia improved.

Current report, 2018

63

M

OS

+

Fahr’s disease, bullous pemphigoid

Corneal endotheliitis

+ by PCR

+ by PCR

HHV-6A

Oral valganciclovir, topical ganciclovir

VA improved to 20/80, the same level before the episode of corneal endotheliitis.

  1. HHV-6 Human herpesvirus-6, DM Diabetes mellitus, NA Information not available, VA Visual acuity, OD Oculus dexter, OS Oculus sinister, PCR Polymerase chain reaction, CSF Cerebrospinal fluid, HHV-6B Human herpesvirus-6 variant B, OU Oculus uterque, HHV-6A Human herpesvirus-6 variant A, ALM Acute type 1 myeloid leukemia, CMV Cytomegalovirus, RA Rheumatoid arthritis, TB Tuberculosis, HSV-1 Human T-cell leukemia virus type 1, HIV Human Immunodeficiency Virus, EBV Epstein-Barr virus