Bilateral Conjunctivitis, Keratitis, and Anterior Uveitis in a Patient Co-infected with Parvovirus B19 and SARS-CoV-2

Abstract

Parvovirus B-19 (B19V) is a common infection in children, occasionally complicated by ocular manifestations. In patients infected with severe acute respiratory syndrome virus (SARS-CoV-2), many cases of bacterial, fungal, and viral co-infections have been described. We report on a case of bilateral conjunctivitis, keratitis, and anterior uveitis that occurred in a patient co-infected by B19V and SARS-CoV-2. A young nurse developed, 20 days after the onset of asthenia and fever, a maculopapular rash and, in the following month, B19V-related arthritis. Shortly after a course of antibiotics and corticosteroids and the resolution of the arthritis, she began to complain of hearing loss and tinnitus. A polymerase chain reaction for SARS-CoV-2, previously negative, turned out positive; IgM for B19V decreased while IgG increased and antinuclear autoantibody and rheumatoid factor test results were positive. Ear symptoms disappeared after a course of prednisone, but eye burning and itching appeared 2 weeks after the coronavirus disease 2019 (COVID-19) positive swab. Bilateral conjunctivitis, keratitis, and anterior uveitis were diagnosed, which responded completely to a topical corticosteroid and mydriatic therapy. No relapses were observed in the following 12 months. The onset and progression of the symptoms, along with the laboratory findings, suggest a double pathogenesis of the ocular manifestations: keratitis and uveitis, along with the ear symptoms, seem to be the expression of an autoimmune reaction to B19V infection, while the conjunctivitis was likely related to direct infection of the conjunctiva by SARS-CoV-2.

Bilateral Anterior Uveitis in the Context of Concurrent HIV and Syphilis Co-infection

“…This trend necessitates heightened vigilance and consideration of syphilis in differential diagnoses of ocular inflammations, especially in the context of HIV co-infection. Our case also draws a parallel to the study on the co-infection of parvovirus B19 and SARS-CoV-2, highlighting the complex interactions of multiple infections impacting ocular health [ 12 - 15 ]. While our case involves different pathogens, the underlying principle of co-infections leading to atypical presentations remains pertinent.…”

Virale Bindehautentzündungen: Befunde, Therapie und Prophylaxe

“…Da der ACE-2-Rezeptor eine Rolle in der Übertragung des SARS-CoV-2-Virus spielt und in der Bindehaut im Vergleich zur Hornhaut stärker exprimiert ist, manifestiert sich primär das Bild einer einfachen Konjunktivitis [39]. Bislang wenig erforscht, können auch virale Koinfektionen von SARS-CoV-2, nachweislich mit Parvovirus B19, die Bindehautentzündung verursachen oder zumindest daran beteiligt sein [40]. Zu nennen wäre hier auch das Epstein-Barr-Virus, welches bei COVID-19, mutmaßlich durch das Tragen von Masken aus dem Mundraum auf das Auge übertragen, eine sekundäre Retinitis verursachen kann und auch generell eine maßgebliche Rolle bei der Ätiopathogenese der Long-COVID-Symptomatik spielt [41,42].…”