Cerebral Whipple's disease as a cause of reversible dementia

T Rossi1, R Haghighipour, M Haghighi

  • 1Unità Operativa di Neurologia, Ospedale Geriatrico Sestilli, I.N.R.C.A., Ancona, Italy. t.rossi@inrca.it

Insights

A rare case of reversible dementia caused by Tropheryma whippelii (TW) infection was successfully treated with antibiotics. Diagnosis was confirmed via PCR, and treatment led to significant clinical and radiological recovery.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Microbiology

Background:

  • Dementia presents a significant clinical challenge, with infectious etiologies being less common but treatable.
  • Tropheryma whippelii (TW) is an unusual bacterial pathogen known to cause systemic illness, including neurological manifestations.

Observation:

  • A patient presented with reversible dementia, prompting investigation into potential underlying causes.
  • Diagnostic workup included molecular methods to detect specific pathogens in bodily fluids.

Findings:

  • Polymerase chain reaction (PCR) confirmed the presence of Tropheryma whippelii (TW) in both serum and cerebrospinal fluid.
  • Antibiotic therapy targeting TW led to marked clinical improvement in cognitive function and resolution of neurological symptoms.
  • Post-treatment PCR assays for TW in serum and cerebrospinal fluid were negative, indicating successful eradication of the pathogen.

Implications:

  • This case highlights the importance of considering and testing for Tropheryma whippelii (TW) in cases of unexplained dementia.
  • Early diagnosis and appropriate antibiotic treatment can lead to complete reversal of neurological deficits caused by TW infection.
  • The findings underscore the utility of PCR in diagnosing and monitoring TW infections.

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