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Whipple's disease scleral nodules: a novel presentation in 2 consecutive patients
Waleed K Alsarhani1, Muhannad I Alkhalifah1, Hind M Alkatan2,3
1Ophthalmology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Background:
Whipple's disease (WD) is a rare, chronic, infection caused by gram-positive filamentous aerobic actinobacterium Tropheryma whipplei occurs classically in the gastrointestinal tract and shows histopathologically foamy macrophages with typical numerous PAS-positive, non-acid fast particles. Ocular WD in the form of uveitis may occur in the absence of systemic disease but has not been reported to present with scleral manifestation. We describe for the first time to the best of our knowledge 2 cases of scleral nodules with typical histopathological morphology of WD and without systemic involvement.
Case Presentation:
The first was a 53-year old diabetic male farmer who presented with 2 nontender right eye scleral nodules for 3 months, had a negative systemic workup, and surgical excision showed Periodic acid Schiff (PAS)-positive eosinophilic structures inside macrophages. Grocott's methenamine silver (GMS) stain and acid-fast bacilli (AFB) stain of the tissue itself were negative. The second case was a 60-year old male who presented with an asymptomatic superior scleral nodule for 4 months, which showed similar appearance and negative GMS and AFB stains.
Conclusion:
WD should be included in the differential diagnosis of scleral nodules even in the absence of systemic symptoms. Surgical excision without systemic treatment resulted in successful outcome without recurrence.
Insights
Whipple's disease (WD) can manifest as scleral nodules without systemic symptoms. Surgical removal of these nodules proved effective, with no recurrence observed in these initial cases.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Pathology
Background:
- Whipple's disease (WD) is a rare bacterial infection typically affecting the gastrointestinal tract.
- Ocular manifestations like uveitis are known, but scleral involvement is previously unreported.
- This study introduces WD presenting as isolated scleral nodules.
Observation:
- Two patients presented with non-tender scleral nodules without systemic signs of WD.
- Histopathological examination revealed characteristic foamy macrophages with PAS-positive structures.
- Standard stains (GMS, AFB) for the causative agent, Tropheryma whipplei, were negative in the affected scleral tissue.
Findings:
- Scleral nodules exhibiting the histopathological features of Whipple's disease were identified.
- The cases highlight WD as a potential cause of scleral lesions.
- Successful management was achieved through surgical excision alone.
Implications:
- Whipple's disease should be considered in the differential diagnosis of unexplained scleral nodules.
- Ophthalmologists should be aware of this rare presentation of WD.
- Surgical intervention may be sufficient for localized scleral WD, avoiding systemic therapy.
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