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Central nervous system relapse of Whipple's disease

Kiyoaki Uryu1, Takashi Sakai, Tomonori Yamamoto

  • 1Department of Respiratory Medicine, Yao Tokushukai General Hospital, Japan. kiyoaki2377@yahoo.co.jp

Internal Medicine (Tokyo, Japan)
|August 7, 2012
PubMed

Insights

Whipple's disease, a rare infection, can relapse in the central nervous system. Early treatment with ceftriaxone sodium (CTRX) is crucial for effective management and preventing neurological complications.

Area of Science:

  • Infectious Diseases
  • Gastroenterology
  • Neurology

Background:

  • Whipple's disease is a rare systemic bacterial infection caused by Tropheryma whipplei.
  • Standard treatment involves antibiotics, but relapses can occur, particularly in the central nervous system.

Observation:

  • A 50-year-old male presented with significant weight loss and gastrointestinal bleeding.
  • Endoscopy revealed duodenal erosion and bleeding, with histopathology confirming Whipple's disease via PAS-positive macrophages.
  • Initial treatment with trimethoprim-sulfamethoxazole led to improvement.

Findings:

  • The patient experienced a central nervous system relapse of Whipple's disease after 6 years of treatment.
  • Tropheryma whipplei DNA was detected in cerebrospinal fluid via PCR.
  • The relapse was successfully treated with ceftriaxone sodium (CTRX).

Implications:

  • Ceftriaxone sodium (CTRX) demonstrates high cerebrospinal fluid (CSF) penetration, making it effective for CNS Whipple's disease.
  • Prolonged initial CTRX therapy (several months) may be important for preventing neurological relapses.
  • This case highlights the importance of monitoring for and effectively treating CNS involvement in Whipple's disease.

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