Ophthalmology/Optometry Clinic, Central Texas Veterans Health Care System: Austin Outpatient Clinic, Austin, Texas.
Optometry Clinic, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.
Optom Vis Sci. 2020 Dec;97(12):1041-1047. doi: 10.1097/OPX.0000000000001618.
Whipple disease is a rare chronic, systemic bacterial infection that predominantly affects the small intestine but also other organs of the body. When left untreated, it can be not only vision threatening but also life threatening because of its central nervous system involvement. Therefore, early detection and treatment are important.
We report a rare case of unilateral optic disc edema as a critical identifying sign of Whipple disease.
An asymptomatic 49-year-old African American man presented for an eye examination and was found to have optic nerve edema of the right eye. His best-corrected visual acuity was 20/20 in the right and left eye. He denied symptoms of diplopia, amaurosis fugax, or eye pain. His medical history was significant for HIV with no recent detectable viral load at the time of his eye examination. The patient denied any other infectious risk factors or changes in medical status. Extensive ophthalmic, neuroimaging, and laboratory investigations were completed as a comprehensive approach to rule out more common etiologies for unilateral optic disc edema. This initial workup yielded no identifying etiology, and the patient was monitored closely with frequent examinations with a retina specialist. Soon after his diagnosis of optic nerve edema, the patient developed new symptoms of chronic diarrhea, weight loss, and fatigue requiring hospitalization. Evaluations by internal medicine and gastroenterology, including serological testing, stool analysis, histological and microbiological analysis, esophagogastroduodenoscopy, and gastrointestinal biopsy, confirmed a diagnosis of Whipple disease that was successfully treated with oral antibiotics.
Whipple disease is a rare cause of infectious optic nerve edema that may present with other rheumatoid and gastrointestinal symptoms. A comprehensive medical approach for investigating unilateral optic nerve edema is paramount in diagnosing and treating Whipple disease.
Whipple 病是一种罕见的慢性、系统性细菌感染，主要影响小肠，但也影响身体的其他器官。如果不治疗，它不仅会威胁视力，还会因为涉及中枢神经系统而威胁生命。因此，早期发现和治疗很重要。
我们报告一例罕见的单侧视盘水肿作为 Whipple 病的一个关键识别标志。
一名无症状的 49 岁非裔美国男子因眼部检查而就诊，发现右眼视神经水肿。他的最佳矫正视力右眼为 20/20，左眼为 20/20。他否认有复视、一过性黑矇或眼痛的症状。他的病史有 HIV，在眼部检查时未检测到最近的可检测病毒载量。患者否认有任何其他感染危险因素或医疗状况变化。为了排除单侧视盘水肿更常见的病因，进行了广泛的眼科、神经影像学和实验室检查。该初步检查未发现明确病因，患者密切监测，定期由视网膜专家进行检查。在他被诊断为视神经水肿后不久，患者出现了新的慢性腹泻、体重减轻和疲劳症状，需要住院治疗。内科和胃肠病学的评估，包括血清学检测、粪便分析、组织学和微生物学分析、食管胃十二指肠镜检查和胃肠道活检，均证实了 Whipple 病的诊断，该病经口服抗生素成功治疗。
Whipple 病是一种罕见的感染性视神经水肿病因，可能伴有其他类风湿和胃肠道症状。全面的医学方法是诊断和治疗 Whipple 病的关键。
