Chronic Bilateral Uveitis as the Presenting Manifestation of Ocular Whipple's Disease Confirmed by Vitreous PCR.

PURPOSE: To report a case of Ocular Whipple's Disease (WD) that presented as chronic bilateral uveitis and to highlight the essential role of molecular diagnostics in reaching a definitive diagnosis.

METHODS

This report describes the case of a 67-year-old female with chronic, refractory uveitis. The patient underwent a diagnostic vitrectomy. The collected vitreous sample was analyzed using histopathology with Periodic Acid-Schiff (PAS) staining, transmission electron microscopy (EM), and polymerase chain reaction (PCR) for Tropheryma whipplei.

RESULTS

Histopathology of the vitreous revealed bubbly histiocytes containing PAS-positive granules, and EM confirmed the presence of Tropheryma whipplei bacteria. PCR analysis of fresh vitreous fluid yielded a positive result for T. whipplei 16S rRNA. In contrast, systemic evaluation, including a duodenl biopsy, was negative for WD. Following treatment with appropriate antibiotics, the patient's ocular inflammation resolved, and visual acuity improved significantly.

CONCLUSION

Ocular WD should be considered in the differential diagnosis for chronic, unexplained uveitis, even when systemic symptoms are absent. PCR analysis of vitreous fluid is an invaluable tool for confirming the diagnosis and is crucial for guiding appropriate, sight-saving therapy.