Atypical Migrating Nummular Retinal Lesions in an Immunosuppressed Patient With Whipple Disease

Whipple disease is a rare systemic infection of Tropheryma whipplei with nonspecific clinical features. Ocular involvement is uncommon but has been reported in both anterior and posterior segments of the eye. We present the case of a 70-year-old man with a history of cutaneous T-cell lymphoma, who developed unilateral ocular inflammation with hypopyon, vitritis, and migrating nummular retinal lesions. Despite intravitreal antimicrobial therapy, inflammation persisted. Four months later, he developed systemic symptoms and findings on duodenal biopsy consistent with Whipple disease. This case highlights an atypical ocular presentation suspected to be associated with Whipple disease and the diagnostic challenges in immunocompromised patients lacking classical gastrointestinal symptoms.