Human herpesvirus 6-associated uveitis with optic neuritis diagnosed by multiplex PCR

  • Nahoko Ogata
  • Naoko Koike
  • Tadanobu Yoshikawa
  • Kanji Takahashi
Clinical Investigation



Human herpesvirus 6 (HHV-6), which is usually responsible for exanthem subitum in children, can be reactivated from its latent state. We report a case of unilateral optic disc edema and retinal vasculitis associated with HHV-6 infection.


A healthy 63-year-old man noted a decrease in the vision of his left eye. On examination, his left eye had moderate mutton-fat keratic precipitates, vitreous opacities, significant optic disc edema surrounded by yellowish-white swelling in the inner retina, retinal arteritis, and cotton-wool-like exudates. He was started on corticosteroid therapy and aspirin. After 1 month, the disc edema was reduced, the cotton wool-like exudates had decreased, and his visual acuity had improved to 10/20 OS. Multiplex polymerase chain reaction (PCR) of an aqueous humor sample revealed the presence of genomic DNA of HHV-6 but not of the other HHVs.


The HHVs are known to infect the ocular tissues, but the differential diagnostic signs of HHV-6 are still not well known. We recommend that multiplex PCR of the aqueous humor be performed to search for the genomic DNA of HHV-6 in suspected cases of herpesviral infection.


Human herpesvirus 6 (HHV-6) Human herpesvirus Uveitis Disc edema Multiplex PCR 


  1. 1.
    Salahuddin SZ, Ablash DV, Markham PD, Josephs SF, Sturzenegger S, Kaplan M, et al. Isolation of a new virus, HBLV, in patients with lymphoproliferative disorders. Science. 1986;234:596–601.PubMedCrossRefGoogle Scholar
  2. 2.
    Schirmer EC, Wyatt LS, Yamanishi K, Frenkel N, Rodriguez WJ. Differentiation between two distinct classes of viruses now classified as human herpesvirus 6. Proc Natl Acad Sci USA. 1991;88:5922–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Dewhurst S, Skrincosky D, van Loon N. Human herpesvirus 6. Expert Rev Mol Med. 1997;5:1–17.Google Scholar
  4. 4.
    Yamanishi K, Okuno T, Shiraki K, Takahashi M, Kondo T, Asano Y, et al. Identification of human herpesvirus-6 as a causal agent for exanthema subitum. Lancet. 1988;1(8594):1065–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Khare MD. Human herpesvirus its impact and influence on infectious diseases and their management. Expert Opin Pharmacother. 2001;2:213–21.PubMedCrossRefGoogle Scholar
  6. 6.
    Tanaka T, Kogawa K, Sasa H, Nonoyama S, Furuya K, Sato K. Rapid and simultaneous detection of 6 types of human herpes virus (herpes simplex virus, varicella-zoster virus, Epstein–Barr virus, cytomegalovirus, human herpes virus 6A/B, and human herpes virus 7) by multiplex PCR assay. Biomed Res. 2009;30:279–85.PubMedCrossRefGoogle Scholar
  7. 7.
    Challoner PB, Smith KT, Parker JD, MacLeod DL, Coulter SN, Rose TM, et al. Plaque-associated expression of human herpesvirus 6 in multiple sclerosis. Proc Natl Acad Sci USA. 1995;92:7440–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Donati D, Akhyani N, Fogdell-Hahn A, Cermelli C, Cassiani-Ingoni R, Vortmeyer A, et al. Detection of human herpesvirus-6 in mesial temporal lobe epilepsy surgical brain resections. Neurology. 2003;61:1405–11.PubMedGoogle Scholar
  9. 9.
    Kimberlin DW, Whitley RJ. Human herpesvirus-6: neurologic implications of a newly-described viral pathogen. J Neurovirol. 1998;5:474–85.CrossRefGoogle Scholar
  10. 10.
    Oberacher-Velten IM, Jonas JB, Jünemann A, Schmidt B. Bilateral optic neuropathy and unilateral tonic pupil associated with acute human herpesvirus 6 infection: a case report. Graefes Arch Clin Exp Ophthalmol. 2005;243:175–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Sugita S, Shimizu N, Kawaguchi T, Akao N, Morio T, Mochizuki M. Identification of human herpesvirus 6 in a patient with severe unilateral panuveitis. Arch Ophthalmol. 2007;125:1426–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Maslin J, Bigaillon C, Froussard F, Enouf V, Nicand E. Acute bilateral uveitis associated with an active human herpesvirus-6 infection. J Infect. 2007;54:237–40.CrossRefGoogle Scholar
  13. 13.
    Qavi HB, Green MT, Lewis DE, Hollinger FB, Pearson G, Ablashi DV. HIV-1 and HHV-6 antigens and transcripts in retinas of patients with AIDS in the absence of human cytomegalovirus. Invest Ophthalmol Vis Sci. 1995;36:2040–7.PubMedGoogle Scholar
  14. 14.
    Fillet AM, Reux I, Joberty C, Fournier JG, Hauw JJ, Le Hoang P, et al. Detection of human herpes virus 6 in AIDS-associated retinitis by means of in situ hybridization, polymerase chain reaction and immunohistochemistry. J Med Virol. 1996;49:289–95.Google Scholar
  15. 15.
    Yamamoto S, Tada R, Shimomura Y, Pavan-Langston D, Dunkel EC, Tano Y. Detecting varicella-zoster virus DNA in iridocyclitis using polymerase chain reaction. Arch Ophthalmol. 1995;113:1358–9.Google Scholar
  16. 16.
    Asano S, Yoshikawa T, Kimura H, Enomoto Y, Ohashi M, Terasaki H, et al. Monitoring herpesvirus DNA in three cases of acute retinal necrosis by real-time PCR. J Clin Virol. 2004;29:206–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Chichili GR, Athmanathan S, Farhatullah S, Gangopadhyay N, Jalali S, Pasricha G, et al. Multiplex polymerase chain reaction for the detection of herpes simplex virus, varicella-zoster virus and cytomegalovirus in ocular specimens. Curr Eye Res. 2003;27:85–90.PubMedCrossRefGoogle Scholar
  18. 18.
    Sugita S, Shimizu N, Watanabe K, Mizukami M, Morio T, Sugamoto Y, et al. Use of multiplex PCR and real-time PCR to detect human herpes virus genome in ocular fluids of patients with uveitis. Br J Ophthalmol. 2008;92:928–32.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Ophthalmological Society 2011

Authors and Affiliations

  • Nahoko Ogata
    • 1
  • Naoko Koike
    • 2
  • Tadanobu Yoshikawa
    • 2
  • Kanji Takahashi
    • 3
  1. 1.Department of OphthalmologyNara Medical UniversityKashiharaJapan
  2. 2.Department of OphthalmologyKansai Medical University, Takii HospitalOsakaJapan
  3. 3.Department of OphthalmologyKansai Medical University, Hirakata HospitalOsakaJapan

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