Ocular involvement in Whipple's disease: light and electron microscopic observations
R. L. Font, N. A. Rao, S. Issarescu and W. J. McEntee
A 52-year-old man had a prolonged history of nondeforming migratory
polyarthritis and a short episode of pericarditis preceding the onset of
bilateral vitreitis and retinitis. The clinical course was characterized by
progressive deterioration of vision, increasing lethargy, and dementia,
leading to coma and death from pneumonia (21 months later). No intestinal
manifestations were recorded. Both eyes, which were removed postmortem,
disclosed numerous PAS-positive macrophages throughout the inner retina and
vitreous. Electron microscopic studies of the macrophages displayed
intracytoplasmic, degenerating, rod-shaped bacteria and membranous
structures identical to those seen in the intestine, brain, heart, and
other tissues of patients with Whipple's disease. Clinicians should include
Whipple's disease, and reticulum cell sarcoma, in the differential
diagnosis of patients with bilateral retinitis and vitreitis, especially if
these disorders are associated with CNS manifestations.
