Progressive Uveitis as a Diagnostic and Therapeutic Challenge in Whipple's Disease

A caucasian male in his 60s presented with a several-month history of weight loss and recurrent fever, accompanied by bilateral sensorineural hearing loss and progressive uveitis. Initial investigations were inconclusive, including Pet CT and duodenal biopsy with Tropheryma whipplei polymerase chain reaction (PCR). Based on a suspicion of autoimmune disease, immunosuppressive treatment was initiated without clinical improvement. Whipple disease (WD) was finally disclosed through positive PCR identification of Trophyrema whipplei in vitreous biopsy and repeated stool sampling. The patient was treated with intravenous ceftriaxone and doxycycline. After a few days of antibiotics, the patient's visual acuity decreased dramatically with left eye pain and hypopyon, suggesting an immune reconstitution inflammatory syndrome (IRIS) and requiring high-dose steroids. This case report highlights the diagnostic and treatment challenges of Whipple's disease, a rare systemic infection often misdiagnosed due to its nonspecific symptoms.