Whipple's disease: multiple hospital admissions of a man with diarrhoea, fever and arthralgia

Magira, Eleni; Gounaris, Theodore; Sioula, Evangelia

doi:10.1016/j.jinf.2004.08.010

Cited by 6 publications

(3 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, our patient was not diagnosed with WD at that time. Multiple hospital admissions are not uncommon before the diagnosis of WD [ 11 ]. According to our previous clinical experience in Whipple’s disease [ 10 , 12 ], our patient’s history and the spectrum of neuro-cognitive features (mild ataxic walking, impaired vertical gaze, dysarthria and myoclonic movements, cognitive impairment, depressive mood) before and during his hospitalization, initial clinical and laboratory findings (which ruled out other diagnosis as possible), and proposed diagnostic procedures in CNS Whipple’s disease [ 13 ], we thought that Whipple’s disease should be included as a possible cause of patient’s signs and symptoms during the last years and thus laboratory examination for Tropheryma Whipplei [ 14 ] was performed that confirmed the diagnosis.…”

Section: Dear Editormentioning

confidence: 99%

Central Nervous System Involvement as Relapse in Undiagnosed Whipple’s Disease with Atypical Symptoms at Onset

Zalonis

Christidi

Potagas

et al. 2015

TONEUJ

View full text Add to dashboard Cite

Whipple’s disease (WD) is a rare systemic disease caused by the gram-positive bacillus Tropheryma Whipplei and mostly characterized by arthralgias, chronic diarrhea, weight loss, fever and abdominal pain. Central Nervous System involvement is not uncommon and it may precede other disease manifestations, appear after treatment and improvement of gastrointestinal signs or rarely be the only WD symptom. We report a case in a middle-aged male with unexplained neurological signs and symptoms which were presented as relapse of previously undiagnosed WD with atypical symptoms at onset. After diagnosis confirmation, the patient was appropriately treated which resulted in improvement of major symptoms.

show abstract

Section: Dear Editormentioning

confidence: 99%

Central Nervous System Involvement as Relapse in Undiagnosed Whipple’s Disease with Atypical Symptoms at Onset

Zalonis

Christidi

Potagas

et al. 2015

TONEUJ

View full text Add to dashboard Cite

show abstract

“…It most commonly presents through the fourth to the sixth decade of life, with arthralgia, abdominal pain, diarrhoea, weight loss and occasionally fever [2]. Invasion of the bacterium through the gastrointesinal mucosa leads to macrophage recruitment to the lamina propria, with obstruction of local lymphatics and small intestinal villus blunting.…”

Section: Introductionmentioning

confidence: 99%

Palindromic Rheumatoid Arthritis-An Unorthodox Presentation of Whipple’s Disease

Santucci¹

2016

SJCM

View full text Add to dashboard Cite

Whipple's disease is a rare infection of the gastrointestinal tract caused by the actinomycete Tropheryma whippelii.It most commonly presents with arthralgia, abdominal pain, diarrhoea and weight loss. Invasion of the bacterium through the gastrointestinal mucosa leads to small intestinal villus blunting and malabsorption. Diagnosis is made by histological examination of small bowel biopsies. We report the case of a 78 year old gentleman who had a two year history of fleeting joint pain and multiple hospital admissions for varying symptoms. He was treated with antibiotics for a chest infection with improvement only to present again after 1 year with anorexia, fatigue, blackish loose stools and epigastric pain. Microscopic examination of duodenal biopsies showed a stunted villous architecture and expansion of the lamina propria by foamy macrophages. These expressed CD68 and cytoplasmic contents were strongly PAS positive, consistent with a diagnosis of Whipple's disease. He was started on intravenous ceftriaxone and a prolonged course of oral co-trimoxazole (at least 1 year) with marked clinical improvement. In retrospect, the previous year's admissions might have also been due to Whipple's disease but since he did not have the full course of the appropriate treatment he relapsed. Whipple's disease is a difficult diagnosis to make because of the variety of clinical symptoms and the long time span between the initial unspecific symptoms (the prodromal stage) and the full-blown clinical picture of the illness (the steady-state stage). It may be misdiagnosed with a non-infectious rheumatic illness and may be fatal if untreated.

show abstract

“…Primary GI disease involvement of WD occurs in one third of the patients [2]. Despite its common GI involvement, there are few publications describing the endoscopic appearance of WD and most of these are single case reports [3,4,5]. Furthermore, most publications describing GI tract involvement in patients with WD lack either endoscopic description or photographic documentation.…”

Section: Introductionmentioning

confidence: 99%

Whipple’s Disease: An Endoscopic and Histologic Study

et al. 2008

View full text Add to dashboard Cite

Background/Aim: Primary gastrointestinal tract involvement occurs in one third of patients with Whipple’s disease (WD). Nevertheless, there are scant data on the endoscopic appearance of WD. The aim of this study was to provide a detailed endoscopic-pathologic assessment of patients with WD. Methods: Four patients with a diagnosis of WD who underwent endoscopic evaluation by a single endoscopist were included. Published information on WD was reviewed in detail, focusing on the endoscopic and histologic features of this disease. Results: WD had a wide range of endoscopic features, including edema, brown discoloration of the mucosa, erythematous spots, subepithelial hemorrhages, and megaduodenum. Magnification endoscopy revealed engorged and flattened villi, villi filled with white material, and white ring-like structures inside of the villi and multiple yellow spots. The histological features of WD include a coarse granular cytoplasm and foamy macrophages that stain strongly with the period acid-Schiff reagent. Conclusions: Gastrointestinal WD has a wide spectrum of endoscopic appearance. Magnification endoscopy enhances the mucosal details. Esophagogastroduodenoscopy with procurement of biopsy specimens from the duodenum was an accurate method for the diagnosis of WD in this case series.

show abstract

Whipple's disease: multiple hospital admissions of a man with diarrhoea, fever and arthralgia

Cited by 6 publications

References 8 publications

Central Nervous System Involvement as Relapse in Undiagnosed Whipple’s Disease with Atypical Symptoms at Onset

Central Nervous System Involvement as Relapse in Undiagnosed Whipple’s Disease with Atypical Symptoms at Onset

Palindromic Rheumatoid Arthritis-An Unorthodox Presentation of Whipple’s Disease

Whipple’s Disease: An Endoscopic and Histologic Study

Contact Info

Product

Resources

About