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Intracerebral Whipple disease: unusual location and bone destruction. Case report
Ziya Akar1, Necmettin Tanriover, Saffet Tüzgen
1Department of Neurosurgery, Cerrahpasa Medical Faculty, University of Istanbul, Turkey. uzan@istanbul.edu.tr
Abstract:
Whipple disease is a rare systemic bacterial infection characterized by migratory polyarthralgia and chronic diarrhea. In 5 to 20% of patients with Whipple disease, the infection may present initially with or eventually develop symptoms related to the central nervous system (CNS). Although CNS involvement is a known feature of systemic Whipple disease, intracerebral mass lesions are uncommon. Mass lesions in these cases are typically deep seated and multifocal. Corticosubcortical regions are unusual sites of CNS involvement in cases of Whipple disease. In the present paper, the authors describe the first case of Whipple disease to feature a single corticosubcortical solid frontoparietal mass lesion that displayed homogeneous contrast enhancement on neuroimaging and was associated with bone destruction of the calvaria. Although CNS involvement has been observed in the form of deep-seated mass lesions in cases of systemic Whipple disease, unusual manifestations should be kept in mind during diagnosis and follow-up review in these patients.
Insights
Whipple disease, a bacterial infection, can affect the central nervous system (CNS). This case highlights an unusual single brain mass lesion in the corticosubcortical region, prompting consideration of rare presentations.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Whipple disease is a rare systemic bacterial infection.
- Central nervous system (CNS) involvement occurs in 5-20% of cases.
- Intracerebral mass lesions are uncommon, typically deep-seated and multifocal.
Observation:
- This paper reports the first case of Whipple disease with a single corticosubcortical solid frontoparietal mass.
- The lesion showed homogeneous contrast enhancement on neuroimaging.
- Associated calvarial bone destruction was noted.
Findings:
- Corticosubcortical Whipple disease mass lesions are rare.
- This presentation differs from typical deep-seated, multifocal CNS involvement.
- The findings emphasize the diverse neurological manifestations of Whipple disease.
Implications:
- Highlights the importance of considering unusual CNS presentations in Whipple disease diagnosis.
- Suggests neuroimaging findings can vary significantly.
- Underscores the need for vigilance in diagnosing and managing atypical cases.