Abstract
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.
Publication types
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Case Reports
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Research Support, Non-U.S. Gov't
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Research Support, U.S. Gov't, P.H.S.
MeSH terms
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Actinobacteria / genetics
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Actinobacteria / isolation & purification*
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Actinomycetales Infections / diagnosis*
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Actinomycetales Infections / drug therapy
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Actinomycetales Infections / microbiology
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Anti-Bacterial Agents
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DNA, Bacterial / analysis
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Drug Therapy, Combination / therapeutic use
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Eye Infections, Bacterial* / diagnosis
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Eye Infections, Bacterial* / drug therapy
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Eye Infections, Bacterial* / microbiology
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Granuloma / diagnosis*
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Granuloma / drug therapy
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Granuloma / microbiology
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Humans
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Iridocyclitis / diagnosis*
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Iridocyclitis / drug therapy
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Iridocyclitis / microbiology
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Jejunum / microbiology
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Lens Capsule, Crystalline / microbiology
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Male
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Middle Aged
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Polymerase Chain Reaction
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Vitreous Body / microbiology
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Whipple Disease / diagnosis*
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Whipple Disease / drug therapy
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Whipple Disease / microbiology
Substances
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Anti-Bacterial Agents
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DNA, Bacterial