OCULAR MANIFESTATIONS OF WHIPPLE-DISEASE - AN ATYPICAL PRESENTATION

A 62-year-old mall developed bilateral granulomatous iridocyclitis aft er uncomplicated cataract surgery. On ophthalmic examination, we found moderate inflammation in the anterior chamber and vitreous, with gran ular crystalline deposits on the iris, intraocular lens, and capsular bag. Biopsy of the lens capsule and vitreous revealed periodic acid-Sc hiff-positive, diastase-resistant bacilli consistent with Tropheryma w hippelii. Electron microscopy and polymerase chain reaction confirmed the diagnosis of Whipple disease. A jejunal biopsy specimen also revea led T whippelii. Treatment with trimethoprim-sulfamethoxazole, cefixim e, rifampin, and doxycycline resulted in improvement of systemic sympt oms, but intraocular inflammation persisted. Intraocular inflammation was eventually reduced with the intravenous administration of ceftriax one sodium.