Atypical presentation of bilateral Epstein-Barr virus dacryoadenitis: a case report of corticosteroid resistant orbital inflammation

Abstract

Epstein-Barr virus is a known cause of dacryoadenitis that is typically sensitive to corticosteroid treatment. When affecting the orbit, particularly the lacrimal gland, Epstein-Barr virus may cause chronic proptosis and a bilateral lacrimal mass effect. We provide a case of bilateral Epstein-Barr virus associated dacryoadenitis initially resistant to corticosteroid treatment requiring biopsy and confirmation by polymerase chain reaction of lacrimal tissue. Herein, we discuss the presentation with associated magnetic resonance imaging and histopathologic images, diagnostic dilemma, and treatment of an atypical case.

Nonspecific Orbital Inflammation (NSOI): Unraveling the Molecular Pathogenesis, Diagnostic Modalities, and Therapeutic Interventions

“…Conversely, systemic infections have also shown an association with the incidence of NSOI, such as upper respiratory tract infections [26,27], paranasal sinusitis [28,29], and vaccination (e.g., influenza, COVID) [30][31][32]. Dacryoadenitis, a possible clinical manifestation of Epstein-Barr virus (EBV), herpes simplex virus (HSV), and SARS-CoV-2 infection [33][34][35][36], can lead to NSOI due to failure of corticosteroid treatment. Similarly, the human immunodeficiency virus (HIV) can lead to the development of orbital myositis in immunosuppressed patients through a process called immune reconstitution inflammatory syndrome, where T cells mediate a proinflammatory phenomenon [37].…”

“…In NSOI tissues, lymphocytic infiltration was found in 57.10% of samples, whereas fibrotic changes were only reported in 12.50% of samples [39]. Furthermore, EBV-encoded small RNAs (EBERs) were found to be expressed in NSOI tissues [34,39,40]. However, a prior study demonstrated the absence of EBV-VCA-IgM in the presence of EBV-VCA-IgM in patients with NSOI, suggesting a past history of EBV infection (i.e., no acute infections were shown) [40].…”