Programm                 "Degeneration und Regeneration– Grundlagen, Diagnostik und Therapie"

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Bilateral Retrobulbar Neuritis – T. Whipplei more Harmless Commensale or Deadly Bacillus?

Uebermuth C. A.
Helios Clinical Centre Wuppertal, University Witten/Herdecke, Dept. of Ophthalmology, Wuppertal

Purpose: Unrecognized and untreated Whipple disease leads to death caused by the involvement of the central nervous system or cardiac complications. Ocular manifestations of Whipple disease (OWD) and atypical manifestations of the Whipple disease are well known in the literature and a few times are described as bilateral ocular inflammations, such as uveitis, retinitis or ophthalmoplegia.
Method: Case report: A 54 year old female patient which visit our clinic in the year 2000 for the first time shows initially the symptoms of an acute bilaterale retrobulbar neuritis. It was possible in the course of the check up to identify Tropheryma whipplei (TW) by PCR of DNA extracted from peripheral blood. Histological results from duodenal biopsy were negative. A minimal leukocytosis occured. On both eyes severe visual field defects and a visual loss dropped at 1/20 could be viewed. After initiation of the systemic treatment with Cetriaxon (2x1g daily i.v.) the TW-PCR from peripheral blood in the follow up examination was negative. In connection with this treatment the patient was treated with Trimethoprim and Sulfamethoxazol over 12 months. Two years after first diagnosis the visual acuity was at 1/30 at the right eye and 1/25 at the left eye. Both eyes showed an postneuritic optic nerve atrophy. Furhter investigations didn´t show another cause for the visual

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