Integrated metagenomic sequencing and phage display-based immunoprecipitation sequencing for presumptive viral infection: a case report

To report a case of uveitis in which unbiased metagenomic sequencing (MDS) and phage immunoprecipitation and sequencing (PhIP-Seq) were performed on intraocular fluid. A female patient with a past medical history of human immunodeficiency virus (HIV-1) who presented with chronic active anterior and intermediate uveitis with cystoid macular edema in the left eye. She had a previous ocular history of viral retinitis presumed to be secondary to cytomegalovirus (CMV). An anterior chamber tap was performed for viral polymerase chain reactions (PCRs), MDS, and pathogen PhIP-Seq. PCR testing and MDS were negative for pathogen genetic materials. PhIP-Seq detected antibody enrichment of CMV, as well as HIV-1, SARS-CoV-2, and Chlamydia trachomatis . The combination of MDS and PhIP-Seq has the potential to provide additional insights into the pathogenesis and the ocular microenvironment of uveitis patients.