Purchase this article with an account.
V. Touitou, F. Fenollar, N. Cassoux, Z. Amoura, B. Wechsler, J.C. Piette, D. Raoult, B. Bodaghi, P. LeHoang; Evaluation of Diagnostic Tools in Whippple’s Disease–Associated Uveitis : Cytological, Molecular and Microbiological Analysis . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5075.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose: To compare diagnostic tools in Whipple’s disease associated uveitis and to determine the most efficient strategy according to their diagnostic value. Methods: Medical records and laboratory results of patients referred between January 1997 and December 2004 for a suspicion of Whipple’s disease have been retrospectively reviewed. Diagnosis was based on cytological analysis of the vitreous or cerebrospinal fluids (CSF) and duodenal or lymph node biopsy specimens. Slides were stained routinely (in sequence) with the periodic–acid–Schiff (PAS). PCR targeting the 16S rDNA sequence of Tropheryma whipplei was performed in all cases. When possible, bacterial culture of Whipple’s bacillus was performed on blood, vitreous, and duodenal biopsy specimens. Treatment was based on administration of trimethoprim–sulfamethoxazole and rifampin for at least 2 years. Results: Diagnosis of Whipple’s disease was highly suspected in 13 cases. Non granulomatous posterior uveitis was the major clinical finding in 11 cases, one patient presented with supranuclear ophthalmoplegia and another patient with bilateral papilledema. Corticosteroids were inefficient in all cases. Extra–ocular symptoms were present in 10 patients. Diagnostic vitrectomy was performed in 11 cases. PAS positive macrophages were detected in all vitreous samples. However, PCR was positive in 4/11 (36%) vitreous specimens, 2/6 (33.3%)CSF. Interestingly, molecular amplification and phylogenetic analysis identified the presence of Arthrobacter sp. in a lymph node biopsy specimen. Tropheryma whipplei was isolated in culture in a case of previously diagnosed systemic sarcoidosis. Uveitis and neuro–ophthalmological findings were controlled after long–term specific antibiotherapy. One patient developed a primary intraocular lymphoma 2 years after cytological diagnosis of Whipple’s disease. Conclusions: Cytological diagnosis of WD remains highly sensitive but non specific. In the absence of serological tools, molecular analysis remains the gold standard for the diagnosis of this bacterial condition. The culture of Tropheryma whipplei, has been established only recently and needs to be evaluated.
This PDF is available to Subscribers Only