Dick Julia, Krauß Patrizia, Hillenkamp Jost, Kohlmorgen Britta, Schoen Christoph
University of Würzburg, Institute for Hygiene and Microbiology, Josef-Schneider-Str. 2 E1, 97080 Wuerzburg, Germany.
Department of Ophthalmology, University Hospital Wuerzburg, Josef-Schneider-Str. 11, 97080 Wuerzburg, Germany.
JMM Case Rep. 2017 Oct 23;4(10):e005124. doi: 10.1099/jmmcr.0.005124. eCollection 2017 Oct.
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. 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 . 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.
是惠普尔病的病原体。在大多数病例中，胃肠道和淋巴组织会受到影响，导致腹泻、吸收不良和发热。在此，我们报告一例缺乏典型惠普尔症状患者出现眼部表现的罕见病例。一名74岁的白种女性在1至2个月的时间里右眼视力模糊，在过去2天伴有刺痛和结膜充血。入院时，患眼视力为手动。眼科检查显示有眼内炎症的典型体征。在初次就诊数小时内进行了诊断性和治疗性的玻璃体切割术，包括玻璃体活检以及玻璃体内注射万古霉素和阿米卡星。玻璃体活检的显微镜分析和微生物培养对细菌和真菌均为阴性。术后抗生素治疗方案包括静脉注射头孢曲松联合局部使用妥布霉素和氧氟沙星。由于经验性治疗，炎症消退，患者在5天后出院，口服头孢泊肟并进行局部抗生素和类固醇治疗。与此同时，玻璃体已通过聚合酶链反应（PCR）检测真细菌16S rRNA基因，结果呈阳性。对PCR产物的分析揭示了一个特定序列。在我们的患者中，眼内炎是惠普尔病的首个也是唯一症状，而大多数惠普尔病患者患有严重的胃肠道症状。当显微镜检查和标准培养方法均为阴性时，对于任何眼内感染都应考虑进行16S rDNA PCR检测。
