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Abstract
Purpose
To report a case of frosted branch angiitis (FBA) associated with Epstein-Barr virus (EBV) infection in a child.
Case summary
A 7-year-old boy presented with bilateral blurred vision. On ophthalmic examination, his best-corrected visual acuity was 20/25 in the right eye and 20/32 in the left eye. The pupils were equal, round, and reactive to light without a relative afferent pupillary defect. He had normal color vision in both eyes. Slit-lamp examination revealed no abnormalities in the anterior parts of the eyes. Fundoscopic examination revealed prominent white sheathing retinal vasculitis predominantly on the veins in all quadrants, as well as macular edema and irregular foveal reflex in both eyes. Fluorescein angiography showed normal blood flow, but late diffuse staining and leakage of the affected vessels. Spectral domain optical coherence tomography (SD-OCT) showed thickening of the vessel walls, swelling due to hyperreflective material, and hyperreflective retinal depositions. Serological tests and the serum polymerase chain reaction for EBV were positive. A diagnosis of FBA associated with EBV was made. He was treated with systemic acyclovir and steroids. The response was rapid, with improvement in visual acuity to 20/20 in both eyes by day 3. After 7 weeks, all clinical signs resolved and SD-OCT examination showed normal vessel wall thickness and the absence of hyperreflective depositions.
References
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Figure 1.
Ultrawide fundus photograph (UWFP) and fluorescein angiogram (FAG) in both eyes at initial presentation. UWFP shows the extensive peripheral perivascular sheathing predominantly on veins in the (A) right and (B) left eye. Late-phase FAG shows the diffuse perivenous staining and dye leakage in the areas of peripheral sheathing with mild macular involvement in the right (C) and left (D) eye.
Figure 2.
Spectraldomain optical coherence tomography (SD-OCT) sections over involved vessels. SD-OCT shows thickening of vessel walls, swelled by hyperreflective material (arrows), and hyperreflective depositions (arrowheads) more localized at the boundaries of outer plexiform layers in the (A) right and (B) left eye, even if also notable in the ganglion cell layer and retinal nerve fiber layer in perivascular areas in the (B) left eye. After 7 weeks, a SD-OCT examination shows a normal vessel wall thickness corresponding to the restored vessels and absence of hyperreflective retinal depositions in the (C) right and (D) left eye.
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