Ocular Whipple's disease: earlier definitive diagnosis.
OBJECTIVE
Whipple's disease is a rare, chronic, and multiorgan bacterial disease that predominantly involves the gut and its lymphatic drainage in middle-aged Caucasian men but may involve the eye. It is often difficult to diagnose and treat. We report results of one more polymerase chain reaction (PCR) analysis-diagnosed ocular Whipple's disease (OWD) case and the care of three new patients with ocular inflammation caused by OWD.


METHODS
Retrospective noncomparative case series.


METHODS
Three patients.


METHODS
Diagnostic PCR was performed on a vitreous sample, medical records of three patients with OWD were reviewed, and a literature review (1907 to present) located 74 OWD cases. Analysis of published OWD cases to seek out factors that contribute to earlier, definitive diagnosis and treatment of OWD is made.


METHODS
Response of ocular inflammation and vision to treatment.


RESULTS
One of 3 new and 4 of 74 published OWD cases reviewed were diagnosed with PCR on vitreous samples and subsequently successfully treated with antibiotics without devastating central nervous system (CNS) sequelae.


CONCLUSIONS
Diagnostic PCR on vitreous samples and recognition of key presenting symptoms in patients with OWD allows earlier definitive diagnosis, when the disease may be more amenable to antibiotic treatment, compared with "late" CNS Whipple's disease in the cases reviewed.
Chan
R Y
RY
Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.
Yannuzzi
L A
LA
Foster
C S
CS
D039903:Actinobacteria / Q000235:genetics / Q000302:isolation & purification*; D000193:Actinomycetales Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D000293:Adolescent; D000368:Aged; 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; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012313:RNA / Q000737:chemistry; D012329:RNA, Bacterial / Q000235:genetics; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D014822:Vitreous Body / Q000382:microbiology; D008061:Whipple Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology
D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; C034477:RNA primers; D012329:RNA, Bacterial; D012336:RNA, Ribosomal, 16S; D012313:RNA