Central nervous system involvement in Whipple's disease.

Area of Science:

• Neurology
• Infectious Diseases
• Radiology

Background:

• Whipple's disease is a rare, chronic, systemic bacterial infection caused by Tropheryma whipplei.
• It classically presents with arthralgias, abdominal pain, diarrhea, and weight loss, but atypical presentations occur.
• Neurological involvement is common but often a late manifestation.

Observation:

• This case highlights Whipple's disease presenting primarily with neurological and psychiatric symptoms.
• Gastrointestinal complaints were notably absent throughout the disease course.
• Cranial computed tomography (CT) showed normal findings initially, but later revealed significant white matter hypodensity and cortical enhancement.

Findings:

• The study details a unique presentation of Whipple's disease with predominant neurological manifestations.
• Serial cranial CT scans demonstrated progressive white matter abnormalities and leptomeningeal enhancement.
• Autopsy findings correlated with the advanced radiological changes observed on CT.

Implications:

• This case underscores the importance of considering Whipple's disease in patients with unexplained neurological deterioration, even without gastrointestinal symptoms.
• Advanced neuroimaging plays a crucial role in diagnosing and monitoring neurological involvement in Whipple's disease.
• Early recognition and treatment are vital to prevent irreversible neurological damage in atypical Whipple's disease presentations.