Ocular manifestations of Whipple disease: an atypical presentation.
A 62-year-old man developed bilateral granulomatous iridocyclitis after uncomplicated cataract surgery. On ophthalmic examination, we found moderate inflammation in the anterior chamber and vitreous, with granular crystalline deposits on the iris, intraocular lens, and capsular bag. Biopsy of the lens capsule and vitreous revealed periodic acid-Schiff-positive, diastase-resistant bacilli consistent with Tropheryma whippelii. Electron microscopy and polymerase chain reaction confirmed the diagnosis of Whipple disease. A jejunal biopsy specimen also revealed T whippelii. Treatment with trimethoprim-sulfamethoxazole, cefixime, rifampin, and doxycycline resulted in improvement of systemic symptoms, but intraocular inflammation persisted. Intraocular inflammation was eventually reduced with the intravenous administration of ceftriaxone sodium.
Williams
J G
JG
University of Illinois at Chicago Eye Center, 60612, USA.
Edward
D P
DP
Tessler
H H
HH
Persing
D H
DH
Mitchell
P S
PS
Goldstein
D A
DA
D039903:Actinobacteria / Q000235:genetics / Q000302:isolation & purification*; D000193:Actinomycetales Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial / Q000032:analysis; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D006099:Granuloma / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D015863:Iridocyclitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D007583:Jejunum / Q000382:microbiology; D007903:Lens Capsule, Crystalline / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D014822:Vitreous Body / Q000382:microbiology; D008061:Whipple Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology
D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial