Rubella virus-associated uveitis: The essentiality of aqueous humor virological analysis.

Julien Provost,Elise Bouthry,Frédéric Mouriaux,Emmanuel Barreau,Oscar Haigh,Igor Leleu,Marc Labetoulle,Antoine Rousseau,Alfred Kobal,Christelle Vauloup-Fellous

doi:10.1177/11206721221087562

Abstract

Rubella virus-associated uveitis (RVAU) classically presents with the clinical features of Fuchs uveitis syndrome (FUS). We report a series RVAU, and discuss the relevance of available diagnostic strategies, and how vaccination could potentially prevent disease. We retrospectively included patients with RV-positive aqueous humor (AH) with RT-PCR and/or intraocular RV-IgG production, between January 2014 and December 2019. RV-IgG titers from AH and serum were compared with other virus-specific IgG titers (VZV and/or CMV and/or HSV-1), to determine the derived Goldmann-Witmer coefficient (GWC'). Clinical findings at presentation and during follow-up are reported, as well as the anti-RV vaccination status. All 13 included patients demonstrated intraocular synthesis of RV-IgG (median GWC': 9.5; 3.2-100). RV-RNA was detected in one patient while PCR results were negative for other HSV1, VZV and CMV. The mean delay in diagnosis was 13 ± 12.6 years, with an initial presentation of FUS in only 3 patients (23%). Only four patients had been vaccinated, but all after the recommended age. As RVAU is a pleiomorphic entity, virological analysis (RV RT-PCR and GWC') of aqueous humor is essential to improve the diagnosis and management of this entity. Improper vaccination against RV appears to be implicated in RVAU.

Highlights

Rubella virus (RV) is a strictly human pathogen transmitted via aerosols to infect the respiratory tract.[1]
Improper vaccination against RV appears to be implicated in RV-associated uveitis (RVAU)
The clinical picture of RV-associated uveitis (RVAU) is somewhat comparable with the so-called Fuchs uveitis syndrome (FUS) in a significant proportion of cases. This clinical entity is characterized by low grade, typically unilateral inflammation of the anterior segment associated with peculiar iris heterochromia and nodules, diffuse keratic precipitates (KPs), a predisposition to develop cataracts and glaucoma and a mild vitritis.[8]

Summary

Introduction

Rubella virus (RV) is a strictly human pathogen transmitted via aerosols to infect the respiratory tract.[1]. The clinical picture of RV-associated uveitis (RVAU) is somewhat comparable with the so-called Fuchs uveitis syndrome (FUS) in a significant proportion of cases. This clinical entity is characterized by low grade, typically unilateral inflammation of the anterior segment associated with peculiar iris heterochromia and nodules, diffuse keratic precipitates (KPs), a predisposition to develop cataracts and glaucoma and a mild vitritis.[8]. FUS has been linked to infection with RV, Herpes simplex virus type 1 (HSV-1) and cytomegalovirus (CMV).[7,9-11] The latter is common in Asian patients, with an onset of disease between the third to fifth decade, while RV predominates in Europeans and occur usually in the second to third decade of life.[7,10,12]. FUS has been linked to infection with RV, Herpes simplex virus type 1 (HSV-1) and cytomegalovirus (CMV).[7,9-11] The latter is common in Asian patients, with an onset of disease between the third to fifth decade, while RV predominates in Europeans and occur usually in the second to third decade of life.[7,10,12] Groen-Hakan recently reported a large series of RVAU with none of the patients being vaccinated against RV, which was compelling for the still-debated role of RV in causing uveitis.[7]

Methods

Results

Conclusion