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Hypersomnia in Whipple disease: case report.
Luís F Maia1, Mónica Marta, Vitor Lopes
1Department of Neurological Disordes and Senses, Hospital Geral de Santo António, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal.
Arquivos De Neuro-Psiquiatria
|October 24, 2006
Summary
Whipple disease, a rare bacterial infection, can cause neurological symptoms like narcolepsy-like daytime sleepiness. This case highlights the importance of considering Whipple disease in patients with unexplained hypersomnia.
Area of Science:
- Infectious Diseases
- Neurology
- Sleep Medicine
Background:
- Whipple disease (WD) is a rare systemic bacterial infection caused by Tropheryma whippelii.
- Neurological manifestations occur in approximately 40% of WD patients, presenting initially or during disease progression.
Observation:
- A 45-year-old male with WD presented with persistent, irresistible daytime somnolence, a symptom potentially linked to his HLA-DQB1*0602 genetic marker.
- Diagnosis was confirmed via duodenal biopsy, revealing Tropheryma whippelii.
- Following treatment, the patient's hypersomnia and narcoleptic symptoms resolved, with normalization of MRI and CSF findings.
Findings:
- Longitudinal neurophysiological studies indicated persistent sleep abnormalities, including fragmentation and reduced slow-wave and REM sleep.
- The hypersomnia and narcoleptic symptoms are hypothesized to stem from Tropheryma whippelii-induced disruption of the hypothalamic hypocretin circuitry.
Implications:
- Whipple disease should be recognized as a potential cause of secondary hypersomnia.
- This case underscores the diverse neurological impacts of Tropheryma whippelii infection and the importance of considering infectious etiologies in sleep disorders.
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