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Postoperative Tropheryma whipplei endophthalmitis – a case report highlighting the additive value of molecular testing

Please always quote using this URN: urn:nbn:de:bvb:20-opus-158823
  • Introduction. Tropheryma whipplei is the causative agent of Whipple’s disease. Gastrointestinal and lymphatic tissues are affected in the majority of cases, resulting in diarrhoea, malabsorption and fever. Here, we report a rare case of ocular manifestation in a patient lacking the typical Whipple symptoms. Case presentation. A 74-year-old Caucasian female presented with blurred vision in the right eye over a period of 1–2 months, accompanied by stinging pain and conjunctival hyperaemia for the last 2 days. Upon admission, visual acuityIntroduction. Tropheryma whipplei is the causative agent of Whipple’s disease. Gastrointestinal and lymphatic tissues are affected in the majority of cases, resulting in diarrhoea, malabsorption and fever. Here, we report a rare case of ocular manifestation in a patient lacking the typical Whipple symptoms. Case presentation. A 74-year-old Caucasian female presented with blurred vision in the right eye over a period of 1–2 months, accompanied by stinging pain and conjunctival hyperaemia for the last 2 days. Upon admission, visual acuity was hand motion in the affected eye. Ophthalmological examination showed typical signs of intraocular inflammation. Diagnostic and therapeutic pars plana vitrectomy including vitreous biopsy and intravitreal instillation of vancomycin and amikacin was performed within hours of initial presentation. Both microscopic analysis and microbial cultures of the vitreous biopsy remained negative for bacteria and fungi. The postoperative antibiotic regime included intravenous administration of ceftriaxone in combination with topical tobramycin and ofloxacin. Due to the empirical therapy the inflammation ceased and the patient was discharged after 5 days with cefpodoxime orally and local antibiotic and steroidal therapy. Meanwhile, the vitreous body had undergone testing by PCR for the eubacterial 16S rRNA gene, which was found to be positive. Analysis of the PCR product revealed a specific sequence of T. whipplei. Conclusion. In our patient, endophthalmitis was the first and only symptom of Morbus Whipple, while most patients with Whipple’s disease suffer from severe gastrointestinal symptoms. 16S rDNA PCR should be considered for any intraocular infection when microscopy and standard culture methods remain negative.show moreshow less

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Metadaten
Author: Julia Dick, Patrizia Krauß, Jost Hillenkamp, Britta Kohlmorgen, Christoph Schoen
URN:urn:nbn:de:bvb:20-opus-158823
Document Type:Journal article
Faculties:Medizinische Fakultät / Augenklinik und Poliklinik
Medizinische Fakultät / Institut für Hygiene und Mikrobiologie
Language:English
Parent Title (English):JMM Case Reports
Year of Completion:2017
Volume:4
Pagenumber:e005124
Source:JMM Case Reports 2017;4;e005124. DOI: 10.1099/jmmcr.0.005124
DOI:https://doi.org/10.1099/jmmcr.0.005124
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Tag:Tropheryma whipplei; Whipple's disease; endophthalmitis; intravenous ceftriaxone; intravitreal vancomycin and amikacin; ocular infection; oral cefpodoxime; oral doxycycline; topic ofloxacin; vitrectomy
Release Date:2018/03/27
Collections:Open-Access-Publikationsfonds / Förderzeitraum 2017
Licence (German):License LogoCC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International