Vertical saccadic palsy may be an early neurologic finding in Whipple disease. In addition, pendular vergence oscillations that occur with contractions of the masticatory muscles may develop. This combination of abnormal movements is known as oculomasticatory myorhythmia. Patients may have only the neurologic manifestations, but more commonly, they also have unexplained fever, diarrhea, cognitive dysfunction, weight loss, and lymphadenopathy. (A video of oculomasticatory myorhythmia is available at the NOVEL [Neuro-Ophthalmology Virtual Education Library] website at http://novel.utah.edu.) Whipple disease can be diagnosed through duodenal biopsy (using periodic acid–Schiff [PAS] staining) to document infection with Tropheryma whipplei or by serologic polymerase chain reaction (PCR) testing. Although Whipple disease is progressive and potentially life-threatening, it is curable with antibiotic therapy.
Schwartz MA, Selhorst JB, Ochs AL, et al. Oculomasticatory myorhythmia: a unique movement disorder occurring in Whipple’s disease. Ann Neurol. 1986;20(6):677–683.
Excerpted from BCSC 2020-2021 series: Section 5 - Neuro-Ophthalmology. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.