Ocular Whipple's disease Earlier definitive diagnosis

Chan, Roxanne; Yannuzzi, Lawrence A.; Foster, C. Stephen

doi:10.1016/s0161-6420(01)00818-1

Cited by 51 publications

(25 citation statements)

References 47 publications

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“…This thrombocytopenia rapidly resolves upon treatment (138). Finally, ocular manifestations have been described (145), and crystalline keratopathy has been reported as a typical characteristic of ocular Whipple's disease (146).…”

Section: Classic Whipple's Diseasementioning

confidence: 98%

Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

et al. 2017

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SUMMARY Whipple's disease is a rare infectious disease that can be fatal if left untreated. The disease is caused by infection with Tropheryma whipplei, a bacterium that may be more common than was initially assumed. Most patients present with nonspecific symptoms, and as routine cultivation of the bacterium is not feasible, it is difficult to diagnose this infection. On the other hand, due to the generic symptoms, infection with this bacterium is actually quite often in the differential diagnosis. The gold standard for diagnosis used to be periodic acid-Schiff (PAS) staining of duodenal biopsy specimens, but PAS staining has a poor specificity and sensitivity. The development of molecular techniques has resulted in more convenient methods for detecting T. whipplei infections, and this has greatly improved the diagnosis of this often missed infection. In addition, the molecular detection of T. whipplei has resulted in an increase in knowledge about its pathogenicity, and this review gives an overview of the new insights in epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of Tropheryma whipplei infections.

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Section: Classic Whipple's Diseasementioning

confidence: 98%

Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

et al. 2017

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“…Whipple's disease is known to be difficult to diagnose and to treat, due to its rarity and because it typically mimics other diseases (Ratnaike, 2000;Chan et al, 2001). The fact that all signs can also occur in the absence of gastrointestinal manifestations makes it even more complicated.…”

Section: Discussionmentioning

confidence: 99%

“…There are no studies concerning the choice and duration of antibiotic treatment (Pron et al, 1999). Current recommendations include initial intravenous therapy with ceftriaxone (2 g per day) for 2 weeks, followed by trimethoprim-sulfamethoxazole (160/ 800 mg twice daily per orum) for at least one year (Chan et al, 2001;Marth and Raoult, 2003).…”

Section: Discussionmentioning

confidence: 99%

Orbital manifestation of whipple's disease: An atypical case

Lieger

Otto

Clemetson

et al. 2007

Journal of Cranio-Maxillofacial Surgery

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“…Systemic manifestations are generally the presenting features of WD.Abdominal complaints, recurrent arthropathy and longstanding fever are particularly common and precede diagnosis for a few years. However, any organ can be involved and there are reports of myocarditis/endocarditis 5,6 , polyserositis 2 , hepatosplenomegaly 2 and uveitis 7 .According to Louis et al 8 , around 80% of CNS WD patients have systemic signs or symptoms at diagnosis.Therefore, in the appropriate clinical setting, considering WD in a patient with neurological deficits can be important. CNS involvement was first described in 1958 9 and much knowledge has emerged since then.…”

Section: Discussionmentioning

confidence: 99%

“…Oculomotor (III), trochlear (IV) and abducens (VI) palsies are not usual either, but reported in at least 5% of affected individuals 7 . Together, cranial nerve abnormalities occur in 25% of cases.…”

Section: Discussionmentioning

confidence: 99%

Whipple's disease with neurological manifestions: case report

França

Castro

Balthazar

et al. 2004

Arq. Neuro-Psiquiatr.

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-Whipple´s disease (WD) is an uncommon multisystem condition caused by the bacillus Tropheryma whipplei. Central nervous system involvement is a classical feature of the disease observed in 20 to 40% of the patients. We report the case of a 62 yeards old man with WD that developed neurological manifestations during its course, and discuss the most usual signs and symptoms focusing on recent diagnostic criteria and novel treatment regimens.KEY WORDS: Whipple´s disease, inflammatory bowel disease, dementia, polyneuropathy. Doença de Whipple com manifestações neurológicas: relato de casoRESUMO -A doença de Whipple (DW) é distúrbio multissistêmico raro causado pelo bacilo Tropheryma whipplei. O envolvimento do sistema nervoso central é um aspecto clássico da doença, sendo observado em 20 a 40% dos pacientes. Relatamos o caso de homem de 62 anos com DW que desenvolveu manifestações neurológicas durante sua evolução, com o objetivo de discutir os sinais e sintomas mais comuns e destacar os critérios diagnósticos e propostas terapêuticas mais recentes. PALAVRAS-CHAVE: doença de Whipple, doença inflamatória intestinal, demência, polineuropatiaWhipple´s disease (WD) or intestinal lypodystrophy was first described in 1907 1 . It is a relatively rare multisystem disorder caused by the gram-positive bacillus Tropheryma whipplei.The usual presenting complaints include pronounced weight loss, mal-absorptive diarrhea (sometimes accompanied by abdominal cramping and bloody stool), recurrent non-deforming polyarthritis and longstanding low grade fever 2 . Cutaneous hyperpigmentation and lymphadenopathy are also common clinical signs. Central nervous system (CNS) involvement is a classical feature of WD observed in 20 to 40% of cases. CNS manifestations are myriad and usually develop in later stages of the illness 3 , often with cranial nerve and cognitive complaints. Approximately 5% of the patients follow an unusual presentation with isolated CNS symptoms 4 . Available data on CNS WD are scant, consisting basically of isolated case reports. Gerard et al. 3 found only 122 reported cases in the literature since 1960, most of them in Europe and North America. To our knowledge, the following case is the first to be reported in Brazil. CASEA 62-year-old white man, retired electrician, came to our Gastroenterologic Clinic in 1989 complaining of increased stool frequency and liquidity, associated with pronounced weight loss (20 Kg) in the last 2 years. Subsequent investigation disclosed a mal-absorptive syndrome, steatorrhoea and hepatosplenomegaly. Six months later, he developed bilateral knee arthritis which subsided spontaneously in two weeks. In 1990, an upper digestive endoscopy combined with multiple gastric and duodenal biopsies was performed. Histologic examination of the bowel specimens revealed flattened villi, small intestinal mucosa laden with distended foamy macrophages in the lamina propria and intracellular periodic acid Schiff (PAS) positive granules ( Figure 1A -1B). Acid-fast bacilli were not identified in Z...

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Ocular Whipple's disease Earlier definitive diagnosis

Cited by 51 publications

References 47 publications

Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

Orbital manifestation of whipple's disease: An atypical case

Whipple's disease with neurological manifestions: case report

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