Uveitis Associated With Human T-cell Lymphotropic Virus Type I

Seroepidemiologic, clinical, and virologic studies were performed to determine whether human T-cell lymphotropic virus type I was closely associated with uveitis in two hospitals. One hospital was in an endemic area of the virus (Miyakonojo, Miyazaki) and the other hospital was in a less endemic area (Kurume). In the endemic area, the seroprevalence of the virus in patients with uveitis without defined causes (35.4%, 62 of 175 patients) was significantly higher than that in patients with nonuveitic ocular diseases (16.1%, 42 of 261 patients), or in patients with uveitis with defined causes (10.3%, eight of 78 patients). The seroprevalence in younger patients (20 to 49 years of age) with uveitis without defined causes in the area was 44.8% (30 of 67 patients), whereas it was only 9.3% (ten of 107 patients) in the other two groups. A similar observation was recorded even in the less endemic area (Kurume). Because the seroprevalence of the virus in the general population is known to be low in younger patients and to increase with age, these findings were interpreted to indicate that the association of human T-cell lymphotropic virus type I with uveitis was significant. Most patients, particularly those aged 20 through 49 years, had an intermediate uveitis characterized by a moderate inflammation in the vitreous body accompanied by an iritis and retinal vasculitis. The ocular symptoms in the patients differed from those of other types of uveitis common in Japan (Behcet's disease, Vogt-Koyanagi-Harada's disease, and toxoplasmosis, for example). Although the symptoms of uveitis are somewhat similar to those in sarcoidosis, none of the patients had any systemic evidence of sarcoidosis. Moreover, the proviral DNA of human T-cell lymphotropic virus type I was detected by polymerase chain reaction by using pol region primers from the inflammatory cells in the anterior chamber in seven of nine seropositive patients with the uveitis, but not in all tested patients with other types of uveitis. These data thus indicate that the uveitis is highly associated with human T-cell lymphotropic virus type I and is a distinct clinical entity.