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Presumed central nervous system Whipple's disease in a child: case report
1Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Abstract:
Whipple's disease is a rare, chronic, multisystem illness that is pathologically characterized by the accumulation of macrophages in the involved tissue that have a positive periodic acid-Schiff reaction. It is typically seen in middle-aged white men, and only four cases involving persons younger than 15 years of age have been reported. CNS Whipple's disease without intestinal manifestations is rare; only six cases have been reported in the literature, all involving adults. We report the case of a young boy with clinical, laboratory, radiographic, and pathological signs and symptoms consistent with CNS Whipple's disease who responded to therapy with trimethoprimsulfamethoxazole.
Insights
This study presents a rare case of Central Nervous System (CNS) Whipple's disease in a child. The young patient responded well to trimethoprim-sulfamethoxazole treatment, offering hope for pediatric cases.
Area of Science:
- Neurology
- Infectious Diseases
- Pathology
Background:
- Whipple's disease is a rare, chronic, multisystem bacterial infection.
- Pathologically, it involves macrophages with a positive periodic acid-Schiff reaction.
- Central Nervous System (CNS) involvement without gastrointestinal symptoms is exceptionally rare, particularly in pediatric patients.
Observation:
- This report details a unique case of a young boy presenting with symptoms indicative of CNS Whipple's disease.
- The patient exhibited clinical, laboratory, radiographic, and pathological findings consistent with the condition.
- This presentation is notable as it occurred in a patient under 15 years of age and lacked typical intestinal manifestations.
Findings:
- The diagnosis of CNS Whipple's disease was established in a pediatric patient.
- The case highlights the possibility of this rare condition manifesting primarily in the CNS in children.
- Successful treatment was achieved using trimethoprim-sulfamethoxazole.
Implications:
- This case expands the known clinical spectrum of Whipple's disease to include pediatric CNS-only presentations.
- It underscores the importance of considering rare infectious etiologies in pediatric neurological disorders.
- The positive response to trimethoprim-sulfamethoxazole suggests this antibiotic regimen may be effective for pediatric CNS Whipple's disease.