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A neuropathologic study of Whipple's disease
Acta Neuropathologica
|December 1, 1979
Summary
Whipple's disease can cause severe, irreversible central nervous system (CNS) damage even after intestinal remission. Autopsy revealed widespread brain lesions and cellular responses, despite the absence of viable organisms.
Area of Science:
- Neurology
- Infectious Diseases
- Pathology
Background:
- Whipple's disease is a rare systemic bacterial infection caused by Tropheryma whipplei.
- Central nervous system (CNS) involvement is a known, often devastating, complication.
Observation:
- A patient achieved intestinal remission of Whipple's disease following antibiotic treatment.
- Despite remission, the patient developed severe and irreversible CNS manifestations.
Findings:
- Gross examination revealed multifocal brain lesions, predominantly in the rhinencephalon, diencephalon, and mesencephalon.
- Progressive neurological deterioration was observed.
- Autopsy did not identify viable Tropheryma whipplei organisms in the brain.
- Non-traditional cells, including astrocytes, pericytes, and choroid plexus cells, were involved in attempting to clear the infection, alongside microglial and ependymal cells.
Implications:
- This case highlights the potential for delayed and severe CNS pathology in Whipple's disease, independent of intestinal bacterial load.
- The cellular response in the brain suggests complex host-pathogen interactions.
- Further research is needed to understand the mechanisms of CNS damage and develop targeted therapies.