Whipple Disease With Central Nervous System Involvement.

Area of Science:

• Infectious Diseases
• Gastroenterology
• Neurology

Background:

• Whipple disease is a rare, chronic, systemic infection caused by Tropheryma whipplei.
• It can present with diverse symptoms, mimicking other conditions like seronegative rheumatoid arthritis and tropical sprue.
• Delayed diagnosis of Whipple disease can lead to fatal outcomes.

Observation:

• A 53-year-old male experienced an 8-month history of diarrhea, weight loss, visual disturbances, and arthralgias.
• Autoimmune testing for arthralgia was negative.
• Tropheryma whipplei was detected via PCR in duodenal biopsy and cerebrospinal fluid.

Findings:

• The case highlights Tropheryma whipplei infection presenting with gastrointestinal, neurological, and rheumatological symptoms.
• Polymerase chain reaction confirmed the presence of Tropheryma whipplei in both duodenal and cerebrospinal fluid.
• The patient's presentation underscores the diagnostic challenge of Whipple disease.

Implications:

• Whipple disease should be considered in patients with unexplained chronic arthritis, GI issues, and cognitive changes.
• Diagnostic suspicion for Whipple disease is important even with co-existing infections like giardiasis.
• Prompt identification and treatment of Tropheryma whipplei are essential for patient survival.