Author reply

Abstract

It is appropriate to raise the matter of whether we consider ocular involvement from Whipple’s disease to be essentially analogous to or a “sign of CNS involvement.” One can use the terms central to refer to central nervous system (CNS) involvement of Whipple’s disease and peripheral involvement to refer to Whipple’s disease manifestations anywhere outside of the CNS (including the eye). Just as in the case of late latent secondary syphilitic uveitis, so too in the instance of ocular manifestations of Whipple’s disease, we believe that the treatment used must be similar to the treatment that one would use for CNS manifestations of the disease. The blood–eye barrier is every bit as sabotaging to cidal doses of antibiotic reaching microbes sequestered in the eye, just as the blood–brain barrier is to cidal levels of antibiotic reaching microbes sequestered in the CNS.I do not have an opinion regarding the usefulness of sequential PCR analysis on spinal fluid in the course of treating an individual with the ocular manifestations (but no CNS manifestations) of Whipple’s disease. We are aware of Pron’s report regarding conversion of positive PCR results to negative results in patients with successfully treated CNS Whipple’s disease. And although it is appropriate to wonder about the value of sequential PCR on spinal fluid in patients with the ocular manifestations of Whipple’s disease, in truth, we simply do not have the data and therefore do not know whether this strategy would be worth the effort, that is, would reduce the probability of late CNS involvement of Whipple’s disease. Additionally, given the rarity of the disease, I would think that it would be extremely difficult to answer the question even with an appropriately designed study. It is appropriate to raise the matter of whether we consider ocular involvement from Whipple’s disease to be essentially analogous to or a “sign of CNS involvement.” One can use the terms central to refer to central nervous system (CNS) involvement of Whipple’s disease and peripheral involvement to refer to Whipple’s disease manifestations anywhere outside of the CNS (including the eye). Just as in the case of late latent secondary syphilitic uveitis, so too in the instance of ocular manifestations of Whipple’s disease, we believe that the treatment used must be similar to the treatment that one would use for CNS manifestations of the disease. The blood–eye barrier is every bit as sabotaging to cidal doses of antibiotic reaching microbes sequestered in the eye, just as the blood–brain barrier is to cidal levels of antibiotic reaching microbes sequestered in the CNS. I do not have an opinion regarding the usefulness of sequential PCR analysis on spinal fluid in the course of treating an individual with the ocular manifestations (but no CNS manifestations) of Whipple’s disease. We are aware of Pron’s report regarding conversion of positive PCR results to negative results in patients with successfully treated CNS Whipple’s disease. And although it is appropriate to wonder about the value of sequential PCR on spinal fluid in patients with the ocular manifestations of Whipple’s disease, in truth, we simply do not have the data and therefore do not know whether this strategy would be worth the effort, that is, would reduce the probability of late CNS involvement of Whipple’s disease. Additionally, given the rarity of the disease, I would think that it would be extremely difficult to answer the question even with an appropriately designed study.