Atypical panuveitis parasitic and Herpes virus co-infection in immunocompetent adults: real co-infection or false positive?

Purpose Acute panuveitis with retinitis diagnosis may sometimes be difficult. Contribution of microbiological analyzes of intraocular samples currently allows a rapid diagnosis to guide therapeutic management when visual function is severely threatened. Methods We report three original cases of panuveitis with retinitis for which analyzes showed concomitant infection with Toxoplasma and Herpes viruses. Results PCR techniques have increased the sensitivity and specificity of diagnostic tests for ocular pathogens, including Toxoplasmosis and Herpes viruses. For Toxoplasmosis, Western blot and Desmonts coefficient remain standards tests in immunocompetent adults. As for central nervous system infections, Herpes viruses PCR is the gold standard test for intraocular samples. The clinical cases described here are atypical and the clinical examination failed to set the diagnosis. The detection of two infectious agents has led to the establishment of a double etiologic treatment, due to the severity of the ocular involvement. However, we may suppose that certain viruses in dormant states can be liberated in an inflammed eye, causing DNA to be detected on PCR testing, making more than one true positive result both possible and clinically relevant. Conclusion In actual clinical use, false-positive results are possible from contamination, and false-negative results are possible from polymorphism, specimen degradation, or failure to sample in the acute stages of disease. It remains difficult to determine the responsibility of both infectious agents revealed. Is it a real co-infection, or false positive?