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Clinicopathologic Report
September 1998

Ocular Manifestations of Whipple Disease: An Atypical Presentation

Author Affiliations

From the University of Illinois at Chicago Eye Center, Chicago (Drs Williams, Edward, Tessler, and Goldstein); and the Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn (Dr Persing and Mr Mitchell).



Arch Ophthalmol. 1998;116(9):1232-1234. doi:10.1001/archopht.116.9.1232

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.