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Primed Mycobacterial Uveitis (PMU) as a Model for Post-Infectious Uveitis

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[Uveitis intermedia in Whipple's disease].

S Vehr¹, A Nestler, A Schütz

¹Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Leipzig, Liebigstrasse 10-14, 04103, Leipzig, Deutschland. stefanie.vehr@web.de

Der Ophthalmologe : Zeitschrift Der Deutschen Ophthalmologischen Gesellschaft

|May 23, 2008

Summary

Whipple's disease, a rare systemic illness, can manifest as intermediate uveitis, causing vision loss. Early diagnosis and treatment are crucial for managing this condition and its ocular complications like cataracts.

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Area of Science:

Ophthalmology
Infectious Diseases
Gastroenterology

Background:

Whipple's disease is a rare systemic bacterial infection.
Ocular manifestations, particularly uveitis, are uncommon but significant.
This case highlights the importance of considering systemic diseases in unexplained uveitis.

Observation:

A 45-year-old man presented with progressive vision loss and bilateral intermediate uveitis.
Duodenal biopsy confirmed Whipple's disease (Tropheryma whipplei).
Despite treatment, ocular inflammation and cataracts persisted, necessitating surgical intervention.

Findings:

Histologic analysis of vitreous and epiretinal membranes revealed periodic acid-Schiff-positive macrophages.
These findings are pathognomonic for Whipple's disease, confirming its ocular involvement.
The case demonstrates a severe, bilateral presentation of ocular Whipple's disease.

Implications:

Whipple's disease should be included in the differential diagnosis for patients with uveitis, especially those with systemic symptoms.
Prompt recognition and treatment of Whipple's disease can prevent severe ocular complications.
This case underscores the multidisciplinary approach required for managing complex systemic infections with ocular sequelae.