565 results on '"Whipple Disease complications"'
Search Results
152. Intermediate uveitis and arthralgia as early symptoms in Whipple's disease.
- Author
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Thaler S, Grisanti S, Klingel K, Raible A, Kempf VA, and Schulte B
- Subjects
- Diagnosis, Differential, Humans, Male, Middle Aged, Arthralgia complications, Uveitis, Intermediate complications, Whipple Disease complications, Whipple Disease diagnosis
- Published
- 2010
- Full Text
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153. Chronic bacterial and parasitic infections and cancer: a review.
- Author
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Samaras V, Rafailidis PI, Mourtzoukou EG, Peppas G, and Falagas ME
- Subjects
- Chlamydia Infections complications, Chronic Disease, Fascioliasis complications, Hidradenitis Suppurativa complications, Humans, Osteomyelitis complications, Schistosomiasis complications, Tuberculosis complications, Typhoid Fever complications, Whipple Disease complications, Bacterial Infections complications, Neoplasms etiology, Parasitic Diseases complications
- Abstract
Background: A relatively underestimated facet of infectious diseases is the association of chronic bacterial and parasitic infections with cancer development. Therefore, we sought to evaluate the evidence regarding the association of such infections with the development of malignancy, excluding the overwhelming evidence of the association of Helicobacter pylori and cancer., Methodology: We searched Pubmed, Cochrane, and Scopus without time limits for relevant articles., Results: There is evidence that some bacterial and parasitic infections are associated with cancer development. The level of evidence of this association varies from high to low; in any case, a long time interval is mandatory for the development of cancer. A high level of evidence exists for the association of Salmonella Typhi with gallbladder and hepatobiliary carcinoma; Opisthorchis viverrini and Clonorchis sinensis with cholangiocarcinoma; Schistosoma hematobium with bladder cancer; chronic osteomyelitis with squamous cell carcinoma of the skin; and hidradenitis suppurativa with squamous cell carcinoma of the skin. In contrast, the level of evidence regarding the association of Chlamydia spp. with cancer is low. Mycobacterium tuberculosis is associated with lung cancer, albeit probably not etiopathogenetically., Conclusions: A considerable number of bacterial infections and parasitic infections are associated with the development of cancer. Further research into recognizing additional associations of bacterial and parasitic infections with cancer is mandatory.
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- 2010
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154. Whipple disease of the central nervous system: an unusual occurrence in association with acquired immune deficiency syndrome.
- Author
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Guthikonda B, Rouah E, Krishnan B, Powell SZ, Goodman JC, Gopinath SP, and Simpson RK
- Subjects
- Acquired Immunodeficiency Syndrome immunology, Adult, Blotting, Western, CD4 Antigens immunology, Central Nervous System Infections microbiology, Diagnosis, Differential, Humans, Magnetic Resonance Imaging, Male, Whipple Disease microbiology, Acquired Immunodeficiency Syndrome complications, Central Nervous System Infections pathology, Whipple Disease complications, Whipple Disease pathology
- Abstract
Whipple disease is a multisystem infectious disease caused by Tropheryma whippleii. It commonly affects the CNS and produces neurological symptoms in 10-20% of cases. Central nervous system Whipple disease occurring in patients with AIDS is extremely rare. The authors present a case of a newly diagnosed AIDS patient in whom intracranial Whipple disease was diagnosed by stereotactic brain biopsy.
- Published
- 2010
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155. Scurvy as the presenting illness of Whipple's disease exacerbated by treatment with etanercept in a patient with ankylosing spondylitis.
- Author
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Hmamouchi I, Costes V, Combe B, and Morel J
- Subjects
- Adult, Antirheumatic Agents adverse effects, Etanercept, Humans, Male, Receptors, Tumor Necrosis Factor, Scurvy diagnosis, Whipple Disease diagnosis, Immunoglobulin G adverse effects, Scurvy complications, Spondylitis, Ankylosing complications, Spondylitis, Ankylosing therapy, Whipple Disease complications
- Published
- 2010
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156. The amnesic syndrome of primary Whipple disease of the brain.
- Author
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Panegyres PK, Foster JK, Fallon M, and Connor C
- Subjects
- Amnesia diagnosis, Female, Humans, Middle Aged, Neuropsychological Tests, Severity of Illness Index, Amnesia complications, Amnesia physiopathology, Brain physiopathology, Whipple Disease complications, Whipple Disease physiopathology
- Abstract
Objective: To describe a case of primary Whipple disease (WD) of the brain, which may manifest as an amnesic syndrome., Materials and Methods: A 46-year-old woman developed primary WD of the brain. The onset was characterized by a short-term amnesic syndrome for several months before the onset of generalized tonic-clonic seizures. Her amnesia was stable throughout her illness., Results: Our patient had impairment of verbal and visual memory tasks with reduced learning. Her amnesic syndrome was secondary to asymmetric bilateral hippocampal atrophy with gliosis involving the mesial temporal structures-all secondary to primary WD of the brain., Conclusions: WD may present as an amnesic syndrome and needs to be thought of as a treatable cause of cognitive dysfunction in young adults.
- Published
- 2010
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- View/download PDF
157. Whipple's disease of the central nervous system.
- Author
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Aksamit AJ
- Subjects
- Central Nervous System Bacterial Infections diagnosis, Central Nervous System Bacterial Infections therapy, Humans, Whipple Disease diagnosis, Whipple Disease therapy, Central Nervous System Bacterial Infections etiology, Central Nervous System Bacterial Infections microbiology, Whipple Disease complications
- Published
- 2010
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158. [Acute dyspnea in a 48-year-old man].
- Author
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Agard C, Grossi O, Pattier S, Espitia-Thibault A, Le Goff B, Audrain M, Ponge T, Raoult D, Hamidou M, and Pagnoux C
- Subjects
- Acute Disease, Antibodies, Antineutrophil Cytoplasmic, Apnea etiology, Humans, Male, Middle Aged, Whipple Disease complications, Whipple Disease immunology, Whipple Disease diagnosis
- Published
- 2010
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159. A less common cause of diarrhoea.
- Author
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Borş S, Karrenbeld A, and Thijs WJ
- Subjects
- Adult, Anti-Bacterial Agents therapeutic use, Biopsy, Capsule Endoscopy, Ceftriaxone therapeutic use, Colonoscopy, Humans, Male, Periodic Acid-Schiff Reaction, Rare Diseases, Trimethoprim, Sulfamethoxazole Drug Combination therapeutic use, Weight Loss, Whipple Disease complications, Whipple Disease epidemiology, Diarrhea etiology, Whipple Disease diagnosis
- Published
- 2009
160. [Whipple's disease manifesting as atypical respiratory manifestations].
- Author
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Nahon S, Marie L, Maurer C, Bouzahzah A, Jouannaud V, Cucherousset J, and Lesgourgues B
- Subjects
- Adult, Female, Humans, Male, Middle Aged, Whipple Disease diagnosis, Respiration Disorders diagnosis, Whipple Disease complications
- Published
- 2009
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161. Asymptomatic pericardial calcification in Whipple's disease.
- Author
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Keane MG, Shariff M, Akbhar A, Trembling P, Cohen P, and Smith G
- Subjects
- Adult, Humans, Male, Calcinosis microbiology, Cardiomyopathies microbiology, Pericardium, Whipple Disease complications
- Published
- 2009
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162. Novel use of amantadine: to treat hiccups.
- Author
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Wilcox SK, Garry A, and Johnson MJ
- Subjects
- Aged, Antidepressive Agents therapeutic use, Fatal Outcome, Humans, Male, Quality of Life, Sertraline therapeutic use, Stroke complications, Whipple Disease complications, Amantadine therapeutic use, Analgesics, Non-Narcotic therapeutic use, Hiccup drug therapy
- Abstract
Persistent hiccups may have a considerable impact on general health through disturbance of diet, sleep, and mood. They can cause exhaustion, malnutrition, dehydration, wound dehiscence, and even death in extreme cases. We report a complex clinical case of intractable hiccups in a patient with cancer of the pancreas and Parkinson's disease and some of the problems encountered when attempting symptom control. We also discuss a potential therapeutic response to a novel agent, amantadine, unlicensed in the treatment of hiccups.
- Published
- 2009
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163. Tropheryma whipplei infection.
- Author
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Freeman HJ
- Subjects
- Anti-Bacterial Agents therapeutic use, Biopsy, Diagnosis, Differential, Duodenum microbiology, Duodenum surgery, Humans, Nervous System Diseases etiology, Nervous System Diseases microbiology, Tropheryma genetics, Tropheryma pathogenicity, Whipple Disease complications, Whipple Disease drug therapy, Whipple Disease pathology, Tropheryma metabolism, Whipple Disease physiopathology
- Abstract
Whipple's disease was initially described in 1907. Over the next century, the clinical and pathological features of this disorder have been better appreciated. Most often, weight loss, diarrhea, abdominal and joint pain occur. Occasionally, other sites of involvement have been documented, including isolated neurological disease, changes in the eyes and culture-negative endocarditis. In the past decade, the responsible organism Tropheryma whipplei has been cultivated, its genome sequenced and its antibiotic susceptibility defined. Although rare, it is a systemic infection that may mimic a wide spectrum of clinical disorders and may have a fatal outcome. If recognized, prolonged antibiotic therapy may be a very successful form of treatment.
- Published
- 2009
- Full Text
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164. [A double-faced myocarditis: Whipple's disease or sarcoidosis?].
- Author
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Benhamou Y, Lachkar S, Cailleux N, Bauer F, Bernet J, Marie I, and Lévesque H
- Subjects
- Anti-Bacterial Agents therapeutic use, Diagnosis, Differential, Drug Therapy, Combination, Early Diagnosis, Electrocardiography, Heart Conduction System, Humans, Hypertension, Pulmonary etiology, Male, Middle Aged, Myocarditis drug therapy, Myocarditis physiopathology, Sarcoidosis drug therapy, Sarcoidosis physiopathology, Treatment Outcome, Whipple Disease drug therapy, Whipple Disease physiopathology, Myocarditis diagnosis, Myocarditis etiology, Sarcoidosis complications, Sarcoidosis diagnosis, Whipple Disease complications, Whipple Disease diagnosis
- Abstract
Introduction: Whipple's disease is a systemic infection that may mimic sarcoidosis in its initial presentation. The heart involvement is not uncommon and consists generally in an endocarditis. Myocarditis is less common and is usually accompanied by impairment of heart conduction., Case Report: We report a 56-year-old man with Whipple's disease associated with a myocarditis, initially diagnosed as having a sarcoidosis with cardiac injury. The contribution of the histology and molecular biology on intestinal sampling made it possible to rectify the diagnosis., Conclusion: The diagnosis of Whipple's disease should be considered in the presence of a systemic granulomatosis with or without heart involvement. Early diagnosis is important because of effectiveness of antibiotic therapy.
- Published
- 2009
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165. Postoperative panophthalmitis caused by Whipple disease.
- Author
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Drancourt M, Fenollar F, Denis D, and Raoult D
- Subjects
- Aged, Female, France, Humans, RNA, Ribosomal, 16S genetics, Sequence Analysis, DNA, Vitreous Body microbiology, Whipple Disease microbiology, Panophthalmitis microbiology, Postoperative Complications microbiology, Tropheryma classification, Tropheryma genetics, Tropheryma isolation & purification, Whipple Disease complications
- Published
- 2009
- Full Text
- View/download PDF
166. [Women with weight loss and abnormal mesenteric lymph nodes].
- Author
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Gallo Alvaro C, Lobo García J, Suárez Pedreira I, and Cárcaba Fernández V
- Subjects
- Aged, Female, Humans, Lymphatic Diseases etiology, Mesentery, Weight Loss, Whipple Disease complications, Whipple Disease diagnosis
- Published
- 2009
- Full Text
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167. Whipple disease: unusual presentation of a protean and sometimes confusing disease.
- Author
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Lo Monaco A, Govoni M, Zelante A, Rinaldi R, Scorrano AR, Di Stefano M, and Trotta F
- Subjects
- Adult, Diarrhea drug therapy, Diarrhea microbiology, Gastroscopy, Hearing Loss, Bilateral drug therapy, Humans, Male, Retinal Vasculitis drug therapy, Weight Loss, Whipple Disease drug therapy, Hearing Loss, Bilateral microbiology, Retinal Vasculitis microbiology, Tropheryma isolation & purification, Whipple Disease complications, Whipple Disease diagnosis
- Abstract
Objectives: To describe an unusual case of Whipple disease (WD) with confusing clinical features at onset and to discuss the diagnostic challenges for the clinician., Methods: Description of a new case of this rare disease and thorough discussion of the atypical clinical manifestations at onset. A literature review, concerning the unusual onset, by means of a MEDLINE search from 1966 to 2007 was done., Results: A 39-year-old man with sudden bilateral blurred vision due to retinal vasculitis and concomitant rapidly evolving symmetrical neurosensory bilateral hearing loss as initial features of WD is described. Due to the clinical manifestations resembling systemic vasculitis, high-dose corticosteroid and pulse cyclophosphamide therapy were started with subsequent appearance of gastrointestinal symptoms (diarrhea and weight loss) and spiking fever, suggesting superimposed infection. After a complete evaluation, including gastroscopy, extensive duodenal-jejunal mucosal involvement was seen, while diffuse infiltration of the duodenal lamina propria with periodic acid-Schiff-positive foamy macrophages was observed on the histological sample. The diagnosis was confirmed by reverse transcriptase-polymerase chain reaction for the DNA of Tropheryma whippelii. To our knowledge, no previous similar clinical onset of WD has been described., Conclusions: To avoid misdiagnosis and therapeutic mistakes, clinicians should be aware of unusual presentations of WD. Because this etiological agent is a difficult to isolate bacterium, diagnosis may be especially problematic in cases without intestinal involvement at onset.
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- 2009
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168. A case of Noonan syndrome and Whipple's disease in the same patient.
- Author
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Karsan SS, Karsan HA, Karsan AS, and McMillen JI
- Subjects
- Adult, Anti-Infective Agents therapeutic use, Biopsy, Female, Humans, Macrophages pathology, Noonan Syndrome pathology, Treatment Outcome, Whipple Disease drug therapy, Whipple Disease pathology, Noonan Syndrome complications, Sulfamethoxazole therapeutic use, Trimethoprim therapeutic use, Whipple Disease complications
- Abstract
We report the first known case of both Noonan syndrome and Whipple's disease occurring in the same patient. A 36-year-old female with history of Noonan syndrome developed fatigue, anorexia, arthritis of the knees and hands with a diffuse hyperpigmented rash, night sweats, and an unintentional fifteen pound weight loss over 4 mo. Small bowel enteroscopy demonstrated mild edematous yellowish mucosa without friability. Random small bowel biopsies revealed extensive periodic acid-Schiff positive material within the foamy macrophages. She was treated with a 12 mo course of trimethoprim-sulfamethoxazole DS with clinical improvement to baseline status.
- Published
- 2009
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169. Whipple's disease with constrictive pericarditis: a rare disease with a rare presentation.
- Author
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Iqbal T, Karovitch A, Veinot J, Saginur R, and Beauchesne L
- Subjects
- Arthralgia complications, Fibrosis, Humans, Intestinal Mucosa pathology, Jejunum pathology, Lymphatic Diseases complications, Lymphatic Diseases pathology, Magnetic Resonance Imaging, Male, Middle Aged, Pericardiectomy, Pericarditis, Constrictive pathology, Pericarditis, Constrictive surgery, Pericardium pathology, Tomography, X-Ray Computed, Pericarditis, Constrictive complications, Whipple Disease complications, Whipple Disease diagnosis
- Abstract
Whipple's disease is a multisystem disease that can affect the heart with predominantly endocardial and pericardial involvement and, less often, myocardial inflammation. Previously diagnosed at autopsy, cardiac involvement in Whipple's disease is being recognized clinically more often. A 58-year-old man with Whipple's-related constrictive pericarditis, arthralgias and lymphadenopathy is described. He underwent antibiotic treatment and pericardiectomy with improvement in his clinical state.
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- 2009
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170. Erythema nodosum-like lesions in treated Whipple's disease: signs of immune reconstitution inflammatory syndrome.
- Author
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Schaller J and Carlson JA
- Subjects
- Adult, Anti-Bacterial Agents therapeutic use, Biopsy, Duodenum pathology, Erythema Nodosum pathology, Humans, Immune Reconstitution Inflammatory Syndrome pathology, Macrophages immunology, Macrophages microbiology, Macrophages pathology, Male, Tropheryma immunology, Whipple Disease drug therapy, Erythema Nodosum immunology, Immune Reconstitution Inflammatory Syndrome immunology, Skin pathology, Tropheryma isolation & purification, Whipple Disease complications, Whipple Disease immunology
- Abstract
Treatment of systemic infections due to mycobacteria and HIV infection can lead to paradoxical worsening, the immune reconstitution inflammatory syndrome, in a minority of patients. Herein we describe a patient with Whipple's disease, a chronic systemic inflammatory disease caused by Tropheryma whipplei, who developed cutaneous and later ocular disease after initiation of antibiotic therapy. A 42-year-old man with a 12-year history of arthralgias presented with deteriorating health, including weight loss, diarrhea, fever, and acral hyperkeratosis. Whipple's disease was suspected and subsequently confirmed by finding periodic acid-Schiff (PAS)-positive foamy macrophages and T whipplei DNA by polymerase chain reaction (PCR) assays in duodenal biopsy specimens. After 5 weeks of antibiotic treatment with ceftriaxone, erythema nodosum (EN)-like lesions developed on the legs and trunk. Notably, lesional and nonlesional skin harbored intracellular and extracellular degenerated bacteria that were associated with a neutrophilic and granulomatous inflammatory response in lesional skin. Continued antibiotic therapy was associated with recurring EN-like skin nodules, orbital swelling, and facial herpes simplex virus 1 infection. Corticosteroid therapy controlled the duration and severity of the EN-like nodules and orbital swelling. Apart from cutaneous hyperpigmentation, skin disease in Whipple's disease is infrequent and can be categorized as disorders due to malnutrition from malabsorption or so-called reversal reactions consisting of reactive erythemas, and neutrophilic and granulomatous responses to T whipplei, the latter of which can represent an immune reconstitution inflammatory reaction after initiation of antibiotic therapy. Finally, based on the presence of T whipplei in normal skin, skin biopsy may serve as another site for diagnostic testing in patients suspected of having Whipple's disease.
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- 2009
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171. [Unexplained lymphadenopathy: Whipple disease].
- Author
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Wientjes CA, Luykx-de Bakker SA, Prins ME, and Lobatto S
- Subjects
- Diagnosis, Differential, Humans, Lymph Nodes microbiology, Lymph Nodes pathology, Lymphatic Diseases drug therapy, Male, Middle Aged, Periodic Acid-Schiff Reaction, Treatment Outcome, Weight Loss, Whipple Disease complications, Whipple Disease drug therapy, Anti-Bacterial Agents therapeutic use, Intestinal Mucosa pathology, Lymphatic Diseases diagnosis, Whipple Disease diagnosis
- Abstract
A 58-year-old man was referred to the internal medicine outpatient department because of abdominal pain and lymphadenopathy. CT imaging revealed multiple mediastinal, para-aortic, mesenteric and pelvic lymphoma. Biopsy of an inguinal lymph node for histology purposes revealed granulomatous lymphadenitis. A watchful waiting approach was adopted. Two and a half years after first presentation, the patient presented with weight loss, fever and night sweats. CT imaging showed progressive lymphadenopathy and hepatosplenomegaly. Histopathological examination of a laparoscopically removed lymph node showed extensive infiltration with macrophages with stained rod-shaped bacteria (periodic acid-Schiff staining), which is typical of Whipple disease. PCR and biopsies of the small intestine confirmed the diagnosis. Antibiotic therapy was started with rapid clinical and biochemical improvement. A year later PCR of the duodenal biopsies was negative and the antibiotics were discontinued. Whipple disease is a rare chronic infection caused by Tropheryma whipplei. Clinical symptoms can vary, so it often takes a long time to diagnose.
- Published
- 2009
172. [Whipple's disease with normal duodenal histology and ankylosing spondylitis].
- Author
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Ahmadi-Simab K and Schnitzler P
- Subjects
- Adult, Anti-Bacterial Agents therapeutic use, Anti-Inflammatory Agents, Non-Steroidal therapeutic use, Biopsy, Ceftriaxone therapeutic use, DNA, Bacterial isolation & purification, Diagnosis, Differential, Diclofenac therapeutic use, Duodenum microbiology, Duodenum pathology, Etanercept, Female, Humans, Ibuprofen therapeutic use, Immunoglobulin G therapeutic use, Polymerase Chain Reaction, Receptors, Tumor Necrosis Factor therapeutic use, Spondylitis, Ankylosing drug therapy, Treatment Outcome, Trimethoprim, Sulfamethoxazole Drug Combination therapeutic use, Tropheryma genetics, Tumor Necrosis Factor-alpha antagonists & inhibitors, Whipple Disease complications, Whipple Disease drug therapy, Spondylitis, Ankylosing complications, Tropheryma isolation & purification, Whipple Disease diagnosis
- Abstract
History and Admission Findings: A 33-year-old woman with increasing back pain was referred to our hospital 8 years ago. As she had ankylosing sacroilitis and peripheral arthritis she was diagnosed as having ankolysing spondylitis with involvement of the peripheral joints. She recently developed persistent diarrhea, abdominal symptoms and weight loss., Investigations: Laboratory findings revealed a chronic inflammatory disease. Infection of the gastrointestinal tract was excluded. Duodenal biopsy was normal on PAS staining, Tropheryma whipplei-DNA was detected by the polymerase chain reaction (PCR)., Treatment and Course: Initially the patient was treated for 6 months with diclofenac and ibuprofen without improvement of her condition. As the spondylitis persisted, she was given anti-TNF-alpha treatment 7 years after the onset of symptoms. When Whipple's disease was diagnosed this treatment was stopped and antibiotics (ceftriaxone) was started and then continued with co-trimoxazole for one year with significantly improvement in her condition., Conclusions: In patients presenting with symptoms involving several organs, rare systemic diseases should be considered. If symptoms are typical of Whipple's disease, but duodenal biopsies are negative on PAS staining, a sensitive PCR assay may detect T. whipplei-DNA confirming this infection. Appropriate antibiotic treatment can then be initiated.
- Published
- 2009
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173. Primary cerebral Whipple disease presenting as Klüver-Bucy syndrome.
- Author
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Leesch W, Fischer I, Staudinger R, Miller DC, and Sathe S
- Subjects
- Amygdala microbiology, Amygdala pathology, Anti-Bacterial Agents therapeutic use, Anti-Infective Agents therapeutic use, Ceftriaxone therapeutic use, Dementia microbiology, Dementia pathology, Diagnosis, Differential, Female, Humans, Kluver-Bucy Syndrome physiopathology, Magnetic Resonance Imaging, Middle Aged, Paresis microbiology, Paresis pathology, Treatment Outcome, Trimethoprim, Sulfamethoxazole Drug Combination therapeutic use, Whipple Disease drug therapy, Kluver-Bucy Syndrome microbiology, Kluver-Bucy Syndrome pathology, Temporal Lobe microbiology, Temporal Lobe pathology, Whipple Disease complications, Whipple Disease pathology
- Published
- 2009
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174. New insights into Whipple's disease - a rare intestinal inflammatory disorder.
- Author
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Marth T
- Subjects
- Humans, Inflammation microbiology, Inflammation pathology, Tropheryma ultrastructure, Whipple Disease etiology, Whipple Disease microbiology, Inflammation complications, Whipple Disease complications, Whipple Disease diagnosis
- Abstract
Whipple's disease (WD) is a rare systemic infectious disorder caused by the actinomycete Tropheryma whipplei. This chronic disease, first described by Whipple as 'intestinal lipodystrophy', affects preferentially middle-aged white men who may present with weight loss, diarrhea, abdominal pain and arthralgia. Thus, it represents an important differential diagnosis of chronic diarrhea. A variety of other clinical patterns, such as involvement of the heart, lung, or central nervous system (CNS), are frequent. In addition, individuals with isolated heart valve involvement or asymptomatic carriers may be observed. The diagnosis often is established by small bowel biopsy, which is characterized by periodic acid-Schiff-positive inclusions representing the causative bacteria. T. whipplei can be detected by specific polymerase chain reaction, immunohistochemistry or electron microscopy and was cultured a few years ago. Several studies show that subtle defects of the cell-mediated immunity exist in active and inactive WD which may predispose individuals with a certain HLA type to a clinical manifestation of T. whipplei infection. As confirmed in a recent controlled trial, most patients respond well to a prolonged antibiotic treatment, but some patients with relapsing disease or CNS manifestation may have a poor prognosis. In the presentation, the relevance of WD in the differential diagnosis of chronic diarrhea and the new findings of this enigmatic rare disorder will be discussed.
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- 2009
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175. Acute fibrinous and organising pneumonia in Whipple's disease.
- Author
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Canessa PA, Pratticò L, Sivori M, Magistrelli P, Fedeli F, Cavazza A, and Calcina G
- Subjects
- Female, Humans, Idiopathic Interstitial Pneumonias complications, Middle Aged, Pleural Effusion etiology, Whipple Disease complications, Whipple Disease diagnosis, Idiopathic Interstitial Pneumonias pathology, Whipple Disease pathology
- Abstract
We report a case of acute fibrinous and organising pneumonia in Whipple's disease with lung improvement after antibiotic therapy. In our knowledge this is the first report of Whipple's disease with acute fibrinous and organising pneumonia.
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- 2008
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176. Whipple's disease-generalized stage.
- Author
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Jackuliak P, Koller T, Baqi L, Plank L, Lasabova Z, Minarik G, and Payer J
- Subjects
- Adult, Biopsy, Cachexia complications, Humans, Hyperpigmentation complications, Lymphatic Diseases complications, Lymphatic Diseases microbiology, Lymphatic Diseases pathology, Male, Steatorrhea complications, Whipple Disease complications, Whipple Disease pathology, Lymph Nodes microbiology, Lymph Nodes pathology, Tropheryma pathogenicity, Whipple Disease diagnosis
- Abstract
Whipple's disease is a chronic inflammatory systemic disorder in which all organs can be invaded by the rod-shaped bacterium Tropheryma whipplei. It is a rare disease and frequently misdiagnosed, though there is no valid estimate of its actual incidence and prevalence. Only about 1,000-1,500 cases have been reported. The clinical course of untreated Whipple's disease can include three stages: (1) a non-specific prodromal stage which includes migratory polyarthralgias; (2) a classic abdominal manifestation which involves weight loss, weakness, chronic diarrhea, and abdominal pain; and (3) a generalized stage characterized by steatorhea, cachexia, lymphadenopathy, hyper-pigmentation, and cardiovascular, pulmonary, and neurological dysfunction. The authors describe a case of a 39-year-old male patient with about a year's history of generalized adenopathy, inappetence, weight loss, progressive weakness, subfebrilities, and convulsive abdominal pain. Following primary exclusion of a tumor disease, a lymph node biopsy demonstrated a typical picture of a granulomatous inflammation-Whipple's lymphadenitis with partial exemption of the Gram reaction, and stain features corresponding to T. whipplei, which is regarded as the etiological agent causing this disorder. Further tests confirmed the generalized form of the disorder, affecting the lymphatic tissues, gastrointestinal system, respiratory system, and nervous system, with sensory and motor polyneuropathy. HLA-B27 antigen, which is frequent among those with Whipple's disease, was also present. Following treatment for three months with antibiotics a significant reduction of the changes typical of Whipple's disease was found upon follow-up biopsy, hence we assume the applied therapy was successful. In our case study we emphasize the atypical course of the disease with dominant generalized lymphadenopathy and only mild gastrointestinal symptoms.
- Published
- 2008
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177. Mosaic-patterned and scalloped duodenal mucosa in Whipple's disease.
- Author
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Armelao F, Portolan F, and Togni R
- Subjects
- Aged, Female, Humans, Duodenum pathology, Intestinal Mucosa pathology, Whipple Disease complications
- Published
- 2008
- Full Text
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178. [Uveitis intermedia in Whipple's disease].
- Author
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Vehr S, Nestler A, Schütz A, Halm U, and Meier P
- Subjects
- Humans, Male, Middle Aged, Uveitis, Intermediate complications, Uveitis, Intermediate therapy, Vision Disorders etiology, Vision Disorders prevention & control, Whipple Disease complications, Whipple Disease therapy
- Abstract
We report a case of a 45-year-old man who complained of progressive vision loss in his right eye. Visual acuity was 20/300 in the right eye and 20/25 in the left eye. Bilateral uveitis intermedia R>L was diagnosed and treated with systemic and local steroids. An internal checkup was also done, and duodenal biopsy identified Whipple's disease. Despite specific antibiotic therapy, the patient's follow-up examination showed increased inflammatory activity R>L and bilateral cataracta complicata. Cataract surgery and pars plana vitrectomy with removal of epiretinal membranes were done. Histologic analysis of the vitreous and epiretinal membranes showed periodic acid-Schiff-positive macrophages, pathognomonic for Whipple's disease. Whipple's disease is a rare but severe disease with multiple manifestations and should be considered a differential diagnosis in uveitis.
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- 2008
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179. Persistent diarrhea.
- Author
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Sackmann M, Vehling V, Schmidt KD, von Streitberg U, and Seitz G
- Subjects
- Adult, Humans, Male, Diarrhea etiology, Whipple Disease complications
- Abstract
A 63-year-old man presented with massive diarrhea and weight loss. This was preceded by nonspecific symptoms for three years, which resembled sarcoidosis. By duodenal biopsy, the diagnosis of Whipples disease was confirmed. Antibiotic treatment resulted in rapid and complete disappearance of signs and symptoms.
- Published
- 2008
180. Isolated central nervous system Whipple's disease causing reversible frontotemporal-like dementia.
- Author
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Benito-León J, Sedano LF, and Louis ED
- Subjects
- Cognition Disorders diagnosis, Cognition Disorders etiology, Dementia etiology, Frontal Lobe pathology, Humans, Male, Middle Aged, Temporal Lobe pathology, Tomography, Emission-Computed, Single-Photon, Central Nervous System Diseases complications, Dementia diagnosis, Whipple Disease complications
- Abstract
We report a patient with a syndrome resembling frontotemporal dementia (FTD); however, on further diagnostic testing, the diagnosis was Whipple's disease. Because Whipple's disease is treatable, it should be considered in the workup of patients with a FTD-like behavioural and cognitive syndrome.
- Published
- 2008
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181. Neuro-Whipple confirmed five years after a presumptive diagnosis of a primitive CNS vasculitis.
- Author
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El Helou J, Saliba G, Kolev I, and Pierrot-Deseilligny C
- Subjects
- Adrenal Cortex Hormones therapeutic use, Adult, Anti-Bacterial Agents therapeutic use, Brain blood supply, Brain pathology, Cerebral Arteries pathology, Cerebral Arteries physiopathology, Cerebrospinal Fluid microbiology, Deglutition Disorders pathology, Deglutition Disorders physiopathology, Diagnosis, Differential, Disease Progression, Female, Gastroenteritis microbiology, Gastroenteritis physiopathology, Humans, Magnetic Resonance Imaging, Paresis pathology, Paresis physiopathology, Polymerase Chain Reaction methods, Predictive Value of Tests, Recurrence, Spinal Cord blood supply, Spinal Cord pathology, Spinal Cord Diseases pathology, Spinal Cord Diseases physiopathology, Time, Treatment Outcome, Tropheryma drug effects, Tropheryma genetics, Vasculitis, Central Nervous System physiopathology, Vertebrobasilar Insufficiency pathology, Vertebrobasilar Insufficiency physiopathology, Whipple Disease drug therapy, Spinal Cord Diseases etiology, Vasculitis, Central Nervous System etiology, Vasculitis, Central Nervous System pathology, Whipple Disease complications, Whipple Disease pathology
- Published
- 2008
- Full Text
- View/download PDF
182. Cardiac complications in Whipple's disease.
- Author
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Hansen A and Mereles D
- Subjects
- Female, Heart Diseases drug therapy, Heart Diseases etiology, Humans, Middle Aged, Ultrasonography, Whipple Disease drug therapy, Heart Diseases diagnostic imaging, Whipple Disease complications
- Abstract
Whipple's disease or intestinal lipodystrophy is an infection induced by Tropheryma whipplei. It is rare with an estimated incidence of 0.4 per million. Symptoms are arthropathy, weight loss, and diarrhoea, but other organs notably the central nervous system may be affected. We demonstrate a case of cardiac complications in Whipple's disease. The patient presented with endocardial infiltrations on TEE examinations and heart failure and improved after antibiotic treatment.
- Published
- 2008
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183. Possible case of CNS Whipple's disease in an adolescent with AIDS.
- Author
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Patel SJ, Huard RC, Keller C, and Foca M
- Subjects
- AIDS-Related Opportunistic Infections microbiology, Adolescent, Biopsy, Brain microbiology, Brain pathology, Brain Diseases microbiology, Central Nervous System Bacterial Infections microbiology, Fatal Outcome, Humans, Male, Polymerase Chain Reaction, Tropheryma genetics, Whipple Disease microbiology, Brain Diseases complications, Central Nervous System Bacterial Infections complications, HIV Infections complications, Tropheryma isolation & purification, Whipple Disease complications
- Abstract
An adolescent with HIV/AIDS presented subacutely with progressive encephalopathy, spastic quadraplegia, and diarrhea. His brain biopsy was suggestive of central nervous system Whipple's disease, a disease rarely described in HIV patients. Due to overlapping, nonspecific symptoms associated with several opportunistic infections and to the difficulty in culturing the causative organism Tropheryma whipplei, Whipple's disease may be more common than previously suspected, and it is an important consideration in patients with AIDS.
- Published
- 2008
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184. [Whipple's disease with segmental lesions in the proximal small intestine].
- Author
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Prassler R, Kempmann T, and Vierling P
- Subjects
- Aged, Anemia, Iron-Deficiency drug therapy, Anemia, Iron-Deficiency etiology, Arthritis, Rheumatoid complications, Arthritis, Rheumatoid drug therapy, Bronchoalveolar Lavage Fluid microbiology, DNA, Bacterial isolation & purification, Diagnosis, Differential, Humans, Injections, Intravenous, Male, Tropheryma genetics, Tropheryma isolation & purification, Ventricular Dysfunction, Left complications, Whipple Disease complications, Anti-Bacterial Agents therapeutic use, Duodenum pathology, Iron administration & dosage, Whipple Disease diagnosis, Whipple Disease drug therapy
- Abstract
History and Admission Findings: A 67-year-old man with anemia was referred to our hospital. He had suffered from rheumatoid arthritis for ten years. Two months before admission he had been an inpatient at another hospital because of heart failure. He presented with edema, slightly elevated temperature and effusion in the right knee., Investigations: Laboratory findings revealed a chronic inflammation and an anemia of iron malabsorption. Duodenal histology showed PAS-positive macrophages typical for Whipple's disease. Tropheryma whippelii-DNA was found by polymerase chain reaction (PCR) in synovial and cerebrospinal fluid and broncho-alveolar lavage., Treatment and Course: Antibiotic therapy was initiated, the antirheumatic medication terminated and iron was administered intravenously. The outcome was satisfactory., Conclusions: Rare systemic diseases should be considered in patients presenting with symptoms involving several organs. Whipple's disease can be cured only by adequate antibiotic therapy. The use of PCR facilitates the correct diagnosis.
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- 2008
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185. Teaching NeuroImage: Oculomasticatory myorhythmia: pathognomonic phenomenology of Whipple disease.
- Author
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Revilla FJ, de la Cruz R, Khardori N, and Espay AJ
- Subjects
- Adult, Anti-Infective Agents therapeutic use, Anti-Infective Agents, Urinary therapeutic use, DNA, Bacterial analysis, DNA, Bacterial cerebrospinal fluid, Facial Muscles innervation, Facial Muscles physiopathology, Humans, Jejunal Diseases complications, Jejunal Diseases diagnosis, Jejunal Diseases microbiology, Male, Masticatory Muscles innervation, Ocular Motility Disorders microbiology, Oculomotor Muscles innervation, Oculomotor Muscles physiopathology, Periodicity, Sulfamethoxazole therapeutic use, Treatment Outcome, Trimethoprim therapeutic use, Tropheryma drug effects, Tropheryma genetics, Tropheryma physiology, Whipple Disease complications, Masticatory Muscles physiopathology, Ocular Motility Disorders physiopathology, Whipple Disease diagnosis, Whipple Disease physiopathology
- Published
- 2008
- Full Text
- View/download PDF
186. Diffuse cortical lesions with hemorrhage in cerebral Whipple's disease.
- Author
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Wu L, Wang X, Wei H, Li C, and Jia J
- Subjects
- Adult, Cerebral Hemorrhage diagnosis, Cerebral Hemorrhage therapy, Humans, Male, Whipple Disease therapy, Cerebral Cortex pathology, Cerebral Hemorrhage etiology, Whipple Disease complications, Whipple Disease pathology
- Abstract
A 30-year-old Chinese male with a history of diarrhea and arthralgia presented for evaluation of progressive dementia, epilepsy, and increased intracranial pressure. Imaging of the brain showed progressive cortical and subcortical lesions with hemorrhage involving the bilateral temporal and occipital lobes, the posterior parietal lobes, and the left frontal lobe. "Foamy" periodic acid-Schiff (PAS)-positive macrophages were demonstrated on brain biopsy. The patient showed clinical improvement following treatment with chloromycetin and sulfadiazine for 2 months. This constitutes the first reported case of cerebral Whipple's disease with diffuse cortical lesions with hemorrhage reported in a Chinese individual. Further, this case points out the significance of early recognition and treatment of cerebral Whipple's disease, especially in those cases with unusual manifestations.
- Published
- 2008
- Full Text
- View/download PDF
187. Recurrent orbital inflammation and Whipple disease.
- Author
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Huerva V, Espinet R, and Galindo C
- Subjects
- Adrenal Cortex Hormones therapeutic use, Anti-Infective Agents therapeutic use, Drug Therapy, Combination, Duodenum, Female, Humans, Inflammation diagnosis, Inflammation drug therapy, Inflammation etiology, Inflammation pathology, Middle Aged, Orbital Diseases diagnosis, Orbital Diseases drug therapy, Orbital Diseases pathology, Secondary Prevention, Tomography, X-Ray Computed, Trimethoprim, Sulfamethoxazole Drug Combination therapeutic use, Whipple Disease drug therapy, Orbital Diseases etiology, Whipple Disease complications
- Abstract
Purpose: To describe a recurrent case of idiopathic orbital inflammation (OI) associated with Whipple disease., Methods: Observational case report., Results: A 63-year-old woman developed myositis or idiopathic orbital inflammation (OI). Whipple disease had been diagnosed 1 year before by duodenal biopsy. OI appeared 1 year following the end of a long course of trimethoprim-sulfamethoxazole treatment. During follow-up months later, recurrent OI was noted in the same and contralateral orbits. Flare-ups of OI were suggestive of disease relapse and subsequent duodenal biopsy confirmed the presence of PAS-positive particles in macrophages. Treatment with trimethoprim-sulfamethoxazole and corticosteroids was necessary to prevent recurrences., Conclusions: Recurrence of duodenal Whipple disease may be associated with an OI picture that is immmunologically mediated.
- Published
- 2008
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188. Premature ovarian failure in suspected Whipple's disease.
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Ferrari S, Di Puppo F, Persico P, and Ferrari A
- Subjects
- Adult, Female, Humans, Hypogonadism diagnosis, Hypogonadism etiology, Primary Ovarian Insufficiency diagnosis, Whipple Disease diagnosis, Primary Ovarian Insufficiency etiology, Whipple Disease complications
- Abstract
Introduction: Whipple's disease is a relapsing systemic infectious disease probably caused by the Gram-positive bacillus Tropheryma whippelii. The diagnosis can be established based on the characteristic histopathological features found in the affected organ (foamy macrophages with a coarsely granular cytoplasm, which stains with PAS, and by means of polymerase chain reaction (PCR) technology)., Case Report: We report a case of a 23-year-old woman affected by suspected Whipple's disease. She presented encephalopathy and neuropathy with inveterate hyperpyrexia and alteration of the hypothalamic-pituitary-ovary axe. She was amenorrheic because of an hypergonadotropic hypogonadism., Discussion: This hypogonadism is possibly due to follicular depletion caused by inveterate hyperpyrexia or T. whipplii localization.
- Published
- 2007
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189. Orbital manifestation of whipple's disease: an atypical case.
- Author
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Lieger O, Otto S, Clemetson IA, Arnold M, and Iizuka T
- Subjects
- Anti-Bacterial Agents therapeutic use, Anti-Infective Agents therapeutic use, Ceftriaxone therapeutic use, Decompression, Surgical, Exophthalmos etiology, Humans, Male, Metronidazole therapeutic use, Middle Aged, Nerve Compression Syndromes etiology, Optic Nerve Diseases etiology, Vision Disorders etiology, Orbital Diseases etiology, Whipple Disease complications
- Abstract
Background: Whipple's disease is a systemic disorder caused by an infection with a gram-positive bacillus, Tropheryma whipplei. Almost every organ system can be affected in Whipple's disease, resulting in varying clinical symptoms., Case Report: As far as we are aware, this report of a 61-year-old male is the first presenting with a periorbital manifestation of the disease, with severe exophthalmos and optic nerve involvement, leading to rapid visual loss. This emergency case was successfully treated by a surgical orbital decompression combined with systemic use of antibiotics and steroids., Conclusion: Whipple's disease can affect the periorbital tissues and the optic nerve, causing massive exophthalmos and serious transient visual loss. In such a case surgical decompression of the affected orbit combined with antibiotics and steroids is a recommended valid treatment option.
- Published
- 2007
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190. Therapy for Whipple's disease.
- Author
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Knaapen HK and Barrera P
- Subjects
- Humans, Nervous System Diseases etiology, Nervous System Diseases pathology, Nervous System Diseases prevention & control, Trimethoprim, Sulfamethoxazole Drug Combination therapeutic use, Whipple Disease complications, Whipple Disease pathology, Anti-Bacterial Agents therapeutic use, Whipple Disease drug therapy
- Abstract
Whipple's disease was first described in 1907, the genomic composition of the causative organism, Tropheryma whipplei, was unravelled in 2003 and its in vitro susceptibility to antibiotics started to be explored in 2004-05. Still today, this knowledge is not fully applied in the recommendations for the therapy of this disease. In this paper, we summarize the current recommendations on antimicrobial therapy for Whipple's disease and propose a shift in the maintenance therapy.
- Published
- 2007
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191. A patient with cerebral Whipple disease with gastric involvement but no gastrointestinal symptoms: a consequence of local protective immunity?
- Author
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Prüss H, Katchanov J, Zschenderlein R, Loddenkemper C, Schneider T, and Moos V
- Subjects
- Biopsy, Brain Diseases complications, Confusion etiology, Duodenum microbiology, Humans, Lymphocytes microbiology, Male, Middle Aged, Paralysis etiology, Sleep Wake Disorders etiology, Brain Diseases microbiology, Pyloric Antrum microbiology, Whipple Disease complications
- Abstract
Whipple disease is a granulomatous infectious disease caused by Tropheryma whipplei. The bacteria accumulate within macrophages, preferentially in the intestinal mucosa. Disease manifestation seems to be linked to immunological abnormalities of macrophages. We describe a patient with cerebral Whipple disease who presented with changes in mental status, confusion, inverse sleep-wake cycle, bilateral ptosis and vertical gaze palsy. Endoscopic biopsy sampling revealed Whipple disease in the gastric antrum but not in the duodenum. Whole blood stimulation displayed reactivity to T. whipplei that was at the lower end of healthy controls while reactivity of duodenal lymphocytes was not diminished. We propose that in cases of neurological symptoms suspicious of Whipple disease with normal duodenal and jenunal findings, biopsy sampling should be extended to the gastric mucosa. The robust reactivity of duodenal lymphocytes may have prevented our patient from developing small bowel disease, whereas the impaired reactivity in peripheral blood lymphocytes might yet explain the bacterial spreading to the central nervous system leading to the rare case of predominant neurological symptoms without relevant systemic involvement.
- Published
- 2007
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192. [Tonsillar hypertrophy and mesenteric adenopathies as the main manifestations in a patient with Whipple's disease].
- Author
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Cosme Jiménez A, Ojeda Pérez E, Neira F, Vaquero Pérez M, Bujanda Fernández de Piérola L, Montalvo I, and Muro Carral N
- Subjects
- Humans, Hypertrophy etiology, Male, Mesentery, Middle Aged, Whipple Disease diagnosis, Lymphatic Diseases etiology, Palatine Tonsil pathology, Whipple Disease complications
- Abstract
Whipple's disease is an infrequent chronic infection caused by Tropheryma whipplei, identified in 1992. Intestinal, articular, central nervous system and cardiac involvement is common. The presence of abdominal adenopathies, especially mesenteric adenopathies, without peripheral adenopathies or gastrointestinal, articular, neurological or cardiac symptoms is rare. We present the case of a male patient with tonsillar hypertrophy, mesenteric adenopathies, fever and constitutional syndrome, leading to suspicion of lymphoma. Biopsy findings of the lingual tonsil and mesenteric adenopathies were compatible with Whipple's disease. The diagnosis was confirmed by blood polymerase chain reaction.
- Published
- 2007
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193. [Whipple's disease].
- Author
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Seguy D
- Subjects
- Humans, Whipple Disease complications, Whipple Disease diagnosis, Whipple Disease drug therapy, Whipple Disease immunology, Whipple Disease microbiology
- Abstract
For many years, Whipple's disease was considered a rare, mainly intestinal disease causing malabsorption. At present, however, it appears to be multivisceral mainly occuring in subjects with specific and subtle cell-mediated immunity defects. Until recently, diagnosis and follow-up of treatment efficacy depended on PAS positive macrophage inclusions in duodenal biopsies. New diagnostic methods based on PCR gene amplification and immunohistochemistry are now available by DNA sequencing and culture, respectively, of the causal bacteria, which was recently renamed Tropheryma whipplei. Although results are still empirical, and the first randomized study is in progress, an evolution in the choice and duration of antibiotic treatment of this normally fatal disease has led to a marked reduction in clinical relapses, especially for neurological manifestations. The present review shows how recent medical advances have completely transformed the understanding of a disease first described a century ago.
- Published
- 2007
- Full Text
- View/download PDF
194. [Extraintestinal manifestations in Whipple's disease].
- Author
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Ynfante Ferrús M, Rodríguez Ortega P, Pallarés Manrique H, and Domínguez Macías A
- Subjects
- Aged, Humans, Male, Panuveitis etiology, Whipple Disease complications
- Published
- 2007
- Full Text
- View/download PDF
195. Refractory Whipple's disease.
- Author
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Fernandez-Urien I, Carretero C, Sola JJ, Muñoz-Navas M, Betes M, Subtil JC, and Armendariz R
- Subjects
- Animals, Biopsy, Diagnosis, Differential, Duodenum parasitology, Duodenum pathology, Follow-Up Studies, Giardia isolation & purification, Giardiasis complications, Giardiasis parasitology, Humans, Intestinal Mucosa parasitology, Intestinal Mucosa pathology, Jejunum pathology, Male, Middle Aged, Recurrence, Whipple Disease complications, Capsule Endoscopy methods, Giardiasis diagnosis, Whipple Disease diagnosis
- Published
- 2007
- Full Text
- View/download PDF
196. Neck pain in chronic whiplash syndrome treated with botulinum toxin. A double-blind, placebo-controlled clinical trial.
- Author
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Padberg M, de Bruijn SF, and Tavy DL
- Subjects
- Adult, Case-Control Studies, Chronic Disease, Double-Blind Method, Female, Follow-Up Studies, Humans, Male, Middle Aged, Outcome Assessment, Health Care methods, Pain Measurement, Anti-Dyskinesia Agents therapeutic use, Botulinum Toxins therapeutic use, Neck Pain drug therapy, Neck Pain etiology, Whipple Disease complications
- Abstract
Objectives: Neck pain in chronic whiplash syndrome is a major burden for patients, healthcare providers and insurance companies. Randomized data on treatment of botulinum toxin in chronic whiplash syndrome are scarce. We conducted a randomized, placebo-controlled clinical trial to prove efficacy of botulinum toxin for neck pain in chronic whiplash syndrome., Methods: 40 patients with chronic whiplash syndrome (whiplash associated disorders grade 1 and 2) were randomly assigned to receive botulinum toxin (maximum 100 units) or placebo (saline) in muscles with increased tenderness., Results: After 12 weeks there was no significant difference between the two treatment groups in decrease of neck pain intensity on VAS (-7.0 mm, 95% confidence interval (CI) [-20.7 to +6.7]), mean number of neck pain days (-1%; 95% CI [-15% to +13%]), neck pain hours per day (-0.14; 95% CI [-3.0 to +2.7]), days on which symptomatic treatment was taken (-0.7%; 95% CI [-15% to +13%]) number of analgesics taken per day (-0.14; 95% CI [-0.6 to +0.4]) and total cervical range of motion (-11 degrees; 95% CI [-40 to +17]). There also was no significant difference in patient's assessment of improvement after week 4, 8 and 12., Conclusions: Botulinum toxin was not proven effective in treatment of neck pain in chronic whiplash syndrome. Increased muscle tenderness alone might not be the major cause of neck pain in whiplash syndrome.
- Published
- 2007
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197. Eosinophilic vasculitis: a rare presentation of Whipple's disease.
- Author
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Al-Hamoudi W, Habbab F, Nudo C, Nahal A, and Flegel K
- Subjects
- Aged, Eosinophilia diagnosis, Humans, Male, Skin Diseases, Vascular diagnosis, Vasculitis diagnosis, Whipple Disease complications, Eosinophilia complications, Skin Diseases, Vascular complications, Vasculitis complications, Whipple Disease diagnosis
- Abstract
Whipple's disease is a multisystem infectious disease caused by the bacterium Tropheryma whippelii. A case with an unusual presentation is reported. A 66-year-old man presented with a febrile vasculitic rash on his forearms. An extensive rheumatological, hematological and infectious workup gave negative results, apart from mild anemia and eosinophilia. An abdominal computed tomography revealed a retroperitoneal lymphadenopathy, and a skin biopsy revealed an eosinophilic vasculitis. This diverted the work toward ruling out a lymphoma or a vasculitic process. A lymph node biopsy was then performed and showed a diffuse neutrophilic inflammation with abundant foamy macrophages, fat necrosis and lipogranuloma formation. These findings were considered to be nonspecific and no further pathological investigation was carried out. After a course of corticosteroids, diarrhea and weight loss predominated and subsequently a diagnosis of Whipple's disease was confirmed on a small-bowel biopsy. Lymph node involvement was then confirmed on re-evaluation using the appropriate stains.
- Published
- 2007
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- View/download PDF
198. [Potentially reversible dementia].
- Author
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Sellal F and Becker H
- Subjects
- Behcet Syndrome complications, Behcet Syndrome therapy, Dementia therapy, Epilepsy complications, Epilepsy therapy, HIV Infections complications, HIV Infections therapy, Hepatolenticular Degeneration complications, Hepatolenticular Degeneration therapy, Humans, Hydrocephalus, Normal Pressure complications, Hydrocephalus, Normal Pressure therapy, Intracranial Hypertension complications, Intracranial Hypertension therapy, Neurosyphilis complications, Neurosyphilis therapy, Sarcoidosis complications, Sarcoidosis therapy, Sleep Apnea Syndromes complications, Sleep Apnea Syndromes therapy, Thyroid Diseases complications, Thyroid Diseases therapy, Vitamin B 12 Deficiency complications, Vitamin B 12 Deficiency therapy, Whipple Disease complications, Whipple Disease therapy, Dementia etiology
- Abstract
Reversible dementia is rare and accounts for approximately 1.5% of all dementias. Systematic ancillary investigations aimed at detecting an infectious disease, an endocrine aetiology or a vitamin deficiency are rarely contributive, but remain relevant since reversible dementia may, very rarely, mimic Alzheimer-type dementia. Aetiological investigations are much better selected and contributory when they rely on a precise analysis of the clinical picture (past medical history, age of the patient, cognitive, psychiatric and behavioural symptoms, type of onset, and associated signs) and of cerebral imaging. Discovering a reversible cause of dementia does not always mean that the patient will completely recover; thus it is more appropriate to use the term "potentially reversible dementia". Finally, when the patient does not recover from dementia, systematic ancillary investigations can identify and treat concomitant reversible conditions, which in nearly 25% of dementia cases contribute to worsening the condition.
- Published
- 2007
- Full Text
- View/download PDF
199. Clinical problem-solving. A stain in time.
- Author
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Jones J, Vellend H, Detsky AS, and Mourad O
- Subjects
- Arthralgia etiology, Arthritis diagnosis, Brain pathology, Cerebrospinal Fluid microbiology, Chest Pain etiology, Diagnosis, Differential, Diarrhea etiology, Female, Humans, Memory Disorders etiology, Middle Aged, Photosensitivity Disorders etiology, Whipple Disease complications, Actinomycetales isolation & purification, Intestine, Small pathology, Whipple Disease diagnosis
- Published
- 2007
- Full Text
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200. Whipple's disease with muscle impairment.
- Author
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Puget M, Iwaz J, Tristan A, and Streichenberger N
- Subjects
- Actinomycetales Infections drug therapy, Aged, Anti-Bacterial Agents therapeutic use, Ceftriaxone therapeutic use, DNA, Bacterial analysis, DNA, Bacterial blood, Diagnosis, Differential, Humans, Magnetic Resonance Imaging, Male, Muscle, Skeletal chemistry, Muscle, Skeletal microbiology, Muscle, Skeletal pathology, Muscular Disorders, Atrophic drug therapy, Treatment Outcome, Whipple Disease drug therapy, Actinomycetales isolation & purification, Actinomycetales Infections complications, Actinomycetales Infections diagnosis, Muscular Disorders, Atrophic diagnosis, Muscular Disorders, Atrophic microbiology, Whipple Disease complications, Whipple Disease diagnosis
- Abstract
A 67-year-old man presented with myalgia, muscle atrophy, and a history of seronegative polyarthritis. Blood tests showed inflammation but no hematologic or immunologic abnormalities. Muscle biopsy revealed no vasculitis or myositis but Tropheryma whipplei was detected by polymerase chain reaction in muscle, blood, and duodenum specimens; this was confirmed by immunohistochemistry. Ceftriaxone led to clinical improvement. Although rare, Whipple's disease should be considered in the differential diagnosis of diffuse myopathy.
- Published
- 2006
- Full Text
- View/download PDF
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