PMC3439939_01
Photographs at initial presentation. (a) Slit lamp photography demonstrates deposits on the anterior lens surface of the right eye. (b) Fundus photography of the right eye shows vitreous debris without other posterior segment abnormalities. (c) Fundus photography of the left eye is unremarkable.
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fig1
Slit-lamp examination OD showed 1+ conjunctival injection, stromal scarring at the LASIK flap interface, 2+ cells in the anterior chamber, and pigment along with some white deposits on the anterior lens surface (Figure 1). Dilated fundus examination OD revealed vitreous debris but no retinal vasculitis or other chorioretinal lesions (Figure 1).
Three months after initial presentation, crystalline deposits are evident at the level of the corneal endothelium (a)-(b). Several months later, numerous foamy macrophages were identified on hematoxylin and eosin (H&E) stained aortic valve tissue (c) that stained robustly with periodic acid-Schiff diastase (d). The presence of organisms was confirmed by polyclonal anti-T. whipplei antibody (e). ((c)-(e)) courtesy of The Centers for Disease Control, Atlanta, GA.
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fig2
Despite treatment with topical, oral, and periocular corticosteroids OD, inflammation persisted and whitish, fluffy endothelial deposits near the limbus in both eyes and an infiltrating "snowflake-like" crystalline keratopathy at the level of the endothelium OD were observed (Figure 2). The lymph node and aortic valve pathology blocks were sent to the Centers for Disease Control (CDC, Atlanta, Georgia) for review, and the presence of T. whipplei was confirmed by PCR, immunohistochemistry (immunoalkaline phosphatase technique), and PAS staining that showed PAS-positive diastase-resistant organisms within macrophages (Figure 2).
Photographs 17 months after initial presentation demonstrating fading of the endothelial crystalline deposits in the right eye (a-b).
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fig3
After cessation of corticosteroid treatment, the crystalline keratopathy (Figure 3) faded and intraocular inflammation resolved.