Materiały źródłowe

• #1 Rheumatological features of Whipple disease | Scientific Reports

  https://www.nature.com/articles/s41598-021-91671-9

  Whipple disease (WD) is a rare infectious systemic disease. An early diagnosis is crucial, as usual anti-rheumatic drugs, especially TNF inhibitors, may worsen the disease course. Classic Whipple disease (CWD) is characterized by the association of nonspecific gastrointestinal symptoms, such as abdominal pain, chronic diarrhoea and weight loss, with articular symptoms, which usually precede the digestive symptoms by several years. Other systemic features may coexist, such as general symptoms (fever, asthenia), cardiac involvement with the occurrence of culture-negative endocarditis, pleural effusion or pericarditis, and sometimes uveitis or a host of nonspecific neurological symptoms (from headache and memory loss to encephalitis and pathognomonic oculomasticatory myorhythmia). More digestive symptoms and systemic biological features were observed in CWD patients than in NCWD patients, but both patient groups had similar outcomes, especially concerning the response to antibiotics and relapse rate. All patients but one presented rheumatological symptoms. Specific rheumatological features are presented in Table 2. Forty-two patients (62%) exclusively had peripheral involvement, while 26 patients (38%) had axial+/ peripheral involvement. Arthritis occurred in 60 patients (88%), inflammatory arthralgia occurred in 62 patients (91%), and inflammatory back pain occurred in 25 patients (37%). Oligoarticular and polyarticular involvement were seen in 48% and 44% of our population, respectively. Palindromic rheumatism was observed in 42 patients, with a trend towards more intermittent presentation in LWD (90%), AWD (92%) and PAWD (67%) than in CWD (50%). The disease evolution after antibiotic treatment is presented in Supplementary Table S5. None of the 68 patients had resistance to antibiotic treatment, with a rapid relief of symptoms and inflammatory syndrome resolution. At the end of antibiotic treatment, 36/43 tested patients had negative PCR results (84%). Relapses occurred in 21/65 patients (32%). Seven patients in the cohort evolved towards chronic rheumatism, all at least one year after antibiotic treatment initiation: 2 with CWD, 1 with LWA and 4 with AWD/PAWD.

• #2 Whipple Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441937/

  Whipple disease is a systemic disorder that not only involves malabsorption from the gastrointestinal tract but also affects other systems like the cardiovascular, central nervous system, joints, and vascular system. […] The typical presentation includes gastrointestinal symptoms that resemble other malabsorption syndromes. The prominent symptoms are weight loss, diarrhea, arthralgias, fever, and abdominal pain. Diarrhea has the usual features of steatorrhea but may be watery. Occult gastrointestinal bleeding is common (up to 80% of patients). Gross bleeding can also be present sometimes. […] At some point, at least one-third of patients will have involvement of the heart. Pericarditis and endocarditis are common (50% to 75%) but rarely produce significant symptoms. […] Other neurological features described in these patients include confusion, seizures, delirium, cognitive impairment, abnormal body movements, hypersomnia, and extrapyramidal symptoms.

• #2 Whipple Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441937/

  The mainstay of treatment for Whipple disease is antibiotic therapy. […] Usually, the prognosis is good with prompt diagnosis and treatment of Whipple disease. The patients feel a lot better within two to three weeks of initiation of the treatment. […] Whipple disease is a progressively debilitating disease if it gets undiagnosed and untreated. Complications from untreated Whipple disease are mainly due to nutritional deficiencies as it interferes with the absorption process of the small intestine.

• #3 Whipple’s disease – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/whipples-disease/symptoms-causes/syc-20378946

  Digestive signs and symptoms are common in Whipple disease and may include: […] Symptoms tend to develop slowly over many years in most people with this disease. In some people, symptoms such as joint pain and weight loss develop years before the digestive symptoms that lead to diagnosis. […] Whipple disease is a progressive and potentially fatal disease. Although the infection is rare, associated deaths continue to be reported. This is due in large part to late diagnoses and delayed treatment. Death often is caused by the spread of the infection to the central nervous system, which can cause irreversible damage.

• #4 Whipple Disease – Digestive Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/digestive-disorders/malabsorption/whipple-disease

  Typical symptoms include diarrhea, inflamed and painful joints, weight loss, and abdominal pain. […] If left untreated, the disease is progressive and fatal. […] Other common symptoms are fever, loss of appetite, fatigue and weakness caused by anemia, cough, and pain when breathing caused by inflammation of the membrane layers covering the lungs (pleura). […] Confusion, memory loss, or uncontrolled eye movements indicate that the infection has spread to the brain. […] If left untreated, Whipple disease becomes progressively worse and is fatal. […] Despite an initial response to antibiotics, however, the disease can come back.

• #5 Whipple’s disease-generalized stage – PubMed

  https://pubmed.ncbi.nlm.nih.gov/18523887/

  Whipple’s disease is a chronic inflammatory systemic disorder in which all organs can be invaded by the rod-shaped bacterium Tropheryma whipplei. 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. […] 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. […] In our case study we emphasize the atypical course of the disease with dominant generalized lymphadenopathy and only mild gastrointestinal symptoms.

• #6 Whipple’s disease | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/whipples-disease?content_id=CON-20378931

  Digestive signs and symptoms are common in Whipple disease and may include: […] Symptoms tend to develop slowly over many years in most people with this disease. In some people, symptoms such as joint pain and weight loss develop years before the digestive symptoms that lead to diagnosis. […] Whipple disease is a progressive and potentially fatal disease. Although the infection is rare, associated deaths continue to be reported. This is due in large part to late diagnoses and delayed treatment. Death often is caused by the spread of the infection to the central nervous system, which can cause irreversible damage. […] Your symptoms should improve within one to two weeks of starting antibiotic treatment and go away entirely within about one month. […] Even after successful treatment, Whipple disease can recur.

• #7 Connecting the Dots: The Many Systemic Manifestations of Whipple Disease – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/january-2012/connecting-the-dots-the-many-systemic-manifestations-of-whipple-disease/

  A 53-year-old black man presented to our medical center with a new-onset seizure. […] The classic clinical manifestations of WD described by George Whipple in 1907 include diarrhea, weight loss, abdominal pain, and arthropathy. […] Joint manifestations typically precede gastrointestinal manifestations by several years in up to 63% of affected individuals. […] In this patient, the onset of arthralgias preceded intestinal symptoms by 9 years. […] The clinical manifestations of Whipple disease vary widely and include gastrointestinal and extraintestinal symptoms, reflecting the systemic nature of the infection. […] Other intestinal symptoms include abdominal bloating, cramps, and anorexia. […] Weight loss is also seen in the majority of patients with Whipple disease. […] Seronegative arthritis, which is the most common extraintestinal symptom, affects the majority of patients.

• #8 Whipple’s disease – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/467

  Affected patients are typically middle-aged white men, who may present with weight loss, arthralgia, diarrhoea, and fever. […] Patients are typically middle-aged white men, who present with arthralgia, weight loss, diarrhoea, and fever. […] Key diagnostic factors include presence of risk factors, diarrhoea, weight loss, arthralgia, and supranuclear ophthalmoplegia. […] Other diagnostic factors include abdominal pain, lymphadenopathy, fever, steatorrhoea, anaemia, skin darkening, confusion, memory impairment, altered level of consciousness, or dementia, apathy, anxiety, depression, hypomania, psychosis, change in personality, myoclonic signs, seizures, nystagmus, brisk reflexes, extensor plantar responses, weakness predominating in arm extensors and leg flexors, hypertonia, amenorrhoea, polydipsia, hyperphagia, decreased libido, ataxia, headaches, oculomasticatory and oculofacioskeletal myorhythmias, hemiparesis, cranial nerve involvement, extrapyramidal movement disorder, and peripheral neuropathies.

• #9 Whipple Disease – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/malabsorption-syndromes/whipple-disease

  Main symptoms are arthritis, weight loss, abdominal pain, and diarrhea. […] The 4 cardinal symptoms of Whipple disease are arthralgia, diarrhea, abdominal pain, and weight loss. […] Usually, the first symptoms are arthralgia and fever. […] Intestinal symptoms (eg, watery diarrhea, steatorrhea, abdominal pain, anorexia, weight loss) usually manifest later, sometimes years after the initial complaint. […] Severe malabsorption may be present in patients diagnosed late in the clinical course. […] Untreated disease is progressive and fatal. […] Relapses are common and may occur years later.

• #10 Whipple’s Disease: Symptoms, Diagnosis, Treatment & More

  https://www.healthline.com/health/whipples-disease

  Whipples disease can affect many different body parts and is associated with various symptoms. […] The most common signs and symptoms of Whipples disease include gastrointestinal symptoms such as weight loss, diarrhea, and abdominal pain. About 80% of people will also experience intestinal bleeding. […] You may also experience fever, swelling in the lower hands and legs, and chronic joint pain and inflammation. […] Other less common symptoms may include: heart problems such as inflammation or murmur, nervous system problems such as loss of muscle control or involuntary muscle contractions, vision problems from eye paralysis or weakness, neurological problems like confusion, seizures, delirium, or problems with sleep, enlarged lymph nodes, hyperkeratosis, purpura, tongue, tooth, or mouth inflammation.

• #10 Whipple’s Disease: Symptoms, Diagnosis, Treatment & More

  https://www.healthline.com/health/whipples-disease

  Whipples disease can lead to death if its not treated properly. However, after treatment begins, many of the symptoms will go away within a month. […] Relapses are common. After you finish your course of antibiotics, you have a 9%15% chance of the bacterium staying in your body, especially if you have nervous system symptoms. […] If you experience a relapse, youre more likely to experience new symptoms, especially neurological ones.

• #11 Whipple’s disease | Altru Health System

  https://www.altru.org/health-library/conditions/whipples-disease

  Whipple disease is a rare bacterial infection that most often affects your joints and digestive system. […] Digestive signs and symptoms are common in Whipple disease and may include: Diarrhea, Stomach cramping and pain, which may worsen after meals, Weight loss, associated with the malabsorption of nutrients. […] Other frequent signs and symptoms associated with Whipple disease include: Inflamed joints, particularly the ankles, knees and wrists, Fatigue, Weakness, Anemia. […] Symptoms tend to develop slowly over many years in most people with this disease. In some people, symptoms such as joint pain and weight loss develop years before the digestive symptoms that lead to diagnosis. […] Whipple disease is a progressive and potentially fatal disease. […] Nutritional deficiencies are common in people with Whipple disease and can lead to fatigue, weakness, weight loss and joint pain.

• #12

  https://journals.lww.com/md-journal/fulltext/2015/04030/gastrointestinal_diagnosis_of_classical_whipple.17.aspx

  At time of diagnosis, 146 patients (76%) presented with gastrointestinal symptoms, that is, chronic diarrhea, and 99 patients with weight loss (52%), whereas 129 patients (68%) displayed inflammatory arthritis. […] The period of time between onset of first symptoms and diagnosis of CWD averaged 7.5 years (ranging from 0 to 51 years). […] Neurological symptoms, such as cognitive changes, ophthalmoplegia, nystagmus, and myoclonia were present in 46 patients (24%). […] However, in 18 patients, diagnosis could not be based on characteristic positive PAS staining of small bowel biopsies, of which in 9 patients, alternative positive tests from their duodenal specimens (eg, T whipplei-specific PCR and/or IHC) could detect T whipplei. […] In our cohort, diagnosis of CWD was based on a positive PAS staining of small bowel biopsies in 173 of the 191 patients (91%). […] However, in 9 patients (4.7%), small bowel biopsies did not give any hint on CWD. […] Thus, in 182 patients (95%), a clear hint toward CWD was obtained from small bowel biopsies.

• #13 Whipple’s Disease: What Is It, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/5958-whipples-disease

  Whipples disease symptoms develop in phases (stages), starting with joint pain thats severe and may come and go. The pain typically affects your large joints your ankles, elbows, hips, knees and shoulders. […] This phase may last seven or eight years before you develop more symptoms, including: Abdominal pain. Diarrhea. Edema (swelling). Fatigue. Fever. Patches of skin that are darker than your usual skin color. Swollen lymph nodes. Unexplained weight loss. […] Between 20% and 40% of people with Whipples disease develop central nervous system issues that cause symptoms like: Balance problems. Confusion. Difficulty swallowing. Memory loss. Personality changes. Seizures. Speech impediments. […] Whipples disease affects your bodys ability to absorb fats, carbohydrates, vitamins and other nutrients from food that passes through your small intestine. Its a progressive disease, meaning that it gets worse over time and causes new and more serious medical issues, including: Anemia (low red blood cells). Dementia. Heart murmur. Oculomasticatory myorhythmia, where your eyes and jaw constantly move side to side. Pleural effusion. Uveitis.

• #13 Whipple’s Disease: What Is It, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/5958-whipples-disease

  Whipples disease that affects your central nervous system can be fatal. […] If youre like most people with Whipples disease, youll feel better soon after you start treatment. But it can take as long as two years for your small intestine to recover completely. […] Treatment often cures Whipples disease, but it can come back after treatment.

• #14 An unusual presentation of Whipples disease: adenopathies, polyarthralgia and dermatomyositis-like symptoms

  https://www.explorationpub.com/Journals/em/Article/1001113

  Whipples disease (WD) is a rare systemic disease caused by gram-positive bacillus bacteria that invades multiple organs mainly the intestinal epithelium. Its manifestation is not only limited to the gastrointestinal tract but it also affects the joints, muscle and skin. This is a case of a 54-year-old male patient with a medical history of chronic arthritis presenting with bilateral progressive calves pain, anterior tibial hyperpigmentation, joints pain, anemia and weight loss. […] The clinical signs include arthralgia, weight loss, diarrhea and abdominal pain, although the clinical manifestations can vary widely. […] WD is frequently associated with rheumatic manifestations (60% of the cases), which precede the gastrointestinal signs in three fourths of the patients. They are often the first symptoms of the disease.

• #14 An unusual presentation of Whipples disease: adenopathies, polyarthralgia and dermatomyositis-like symptoms

  https://www.explorationpub.com/Journals/em/Article/1001113

  Joints and musculoskeletal manifestations are as following: migratory or additive non-destructive arthralgia involving large joints. Polyarthralgia including symmetric and asymmetric is often intermittent while articular attacks are acute and last for days. […] Arthralgias and articular attacks precede intestinal symptoms several years. […] Myositis is also reported to be associated with WD. […] Around the malar and orbital hyperpigmentation, purpura and cheilitis are the main skin manifestations of WD. A variety of skin lesions have been described in association with WD and the most common of these is hyperpigmentation or melanoderma that develops in up to 46% of patients in the later stages of the illness. […] Fever may occur for years and is mainly low grade and intermittent. […] WD is a rare systemic infection with T. whipplei, which is still a challenge to diagnose as its clinical manifestations are not specific, resembling many other systemic diseases and may manifest late during the course of the disease. Several years usually elapse between symptom onset, characteristic clinical manifestations and the diagnosis. […] To avoid misdiagnosis, clinicians should be aware of this unusual presentation of WD, mimicking an autoimmune disease with dermatomyositis-like presentation that should be a part of the list of the differential diagnosis, as delay in diagnosis may be life-threatening.

• #15 The Great Unknown, Whipple’s Disease | Reumatología Clínica

  https://www.reumatologiaclinica.org/en-the-great-unknown-whipple-s-disease-articulo-S2173574317300655

  Whipple’s disease was first described by George Hoyt Whipple in 1907. It is a multisystem infectious disease, produced by Tropheryma whipplei, which was identified for the first time in 1991. The clinical signs include arthralgia, weight loss, diarrhea and abdominal pain, although the clinical manifestations can vary widely. Thus it may take up to 6 years to be diagnosed. […] Whipple’s disease is frequently associated with rheumatic manifestations (60% of the cases), which precede the gastrointestinal signs in three fourths of the patients. They are often the first symptoms of the disease. They commonly appear in the form of polyarthritis, generally chronic, intermittent, seronegative and nonerosive, although cases have been reported in which there are atypical rheumatic symptoms such as spondylodiscitis, erosive arthritis, and even osteonecrosis of the hip. The joints most frequently affected are the carpi and large joints of the lower limbs.

• #16 Central Nervous System Involvement as Relapse in Undiagnosed Whipple’s Disease with Atypical Symptoms at Onset

  https://openneurologyjournal.com/VOLUME/9/PAGE/21/FULLTEXT/

  Whipples disease (WD) is a rare systemic disease caused by the gram-positive bacillus Tropheryma Whipplei and mostly characterized by arthralgias, chronic diarrhea, weight loss, fever and abdominal pain. […] CNS involvement is not uncommon and it may precede other disease manifestations, appear after treatment and improvement of gastrointestinal signs or more rarely be the only WD symptom. […] CNS involvement occurs in approximately 50% of WD postmortem examinations; CNS clinical manifestations are observed in only 20-40% of patients whereas approximately 5% of patients present with CNS symptoms alone. […] Relapses after treatment are not rare and CNS manifestations carry the highest relapse rate. […] Isolated CNS manifestations presenting as relapse of previously treated WD but without histological evidence of intestinal involvement have been observed during or years after antibiotic treatment, specifically when the initial therapy is of short duration, making the treatment of relapse more difficult than the first manifestations.

• #17 Whipple Disease Clinical Presentation: History, Physical Examination

  https://emedicine.medscape.com/article/183350-clinical

  In a retrospective study, neurologic symptoms in 18 patients with Whipple disease and CNS infection (median follow-up, 6 y) included the following: confusion or coma related to meningoencephalitis or status epilepticus (17%); delirium (17%); cognitive impairment (memory loss, attention defects, typical frontal lobe syndrome) (61%); hypersomnia (17%); abnormal movements (eg, myoclonus, choreiform movements, oculomasticatory myorhythmia) (39%); cerebellar ataxia (11%); upper motor neuron symptoms (44%); extrapyramidal symptoms (33%); and ophthalmoplegia, with/without progressive supranuclear palsy (17%).

• #17 Whipple Disease Clinical Presentation: History, Physical Examination

  https://emedicine.medscape.com/article/183350-clinical

  Whipple disease was first described by Dr. George H. Whipple in 1907. The classic presentation of Whipple disease is that of a wasting illness characterized by arthralgias, arthritis, fever, and diarrhea; however, this form is rare. […] Approximately 90% of patients with Whipple disease present with weight loss, and 70% of patients with Whipple disease complain of either diarrhea or arthralgias. In about three quarters of patients, the joint manifestations are followed by weight loss and diarrhea, with a mean time of 6 years from onset of the joint symptoms to diagnosis of Whipple disease. […] Occult gastrointestinal (GI) bleeding can be found in 80% of patients of Whipple disease, but frank hematochezia is uncommon. […] Cardiac involvement occurs in approximately 30% of cases. […] When the CNS is involved, patients may demonstrate signs of frontal release (as seen with dementia), meningoencephalitis, or ataxia and clonus (if the cerebellum is affected).

• #18 Whipple disease | MedLink Neurology

  https://www.medlink.com/articles/whipple-disease

  Neurologic features may be found in about one third of patients with systemic Whipple disease, but they are very diverse. Cognitive changes, supranuclear ophthalmoplegia, and altered levels of consciousness are the most common. […] The neurologic features of primary Whipple disease of the brain include hemiparesis, cognitive dysfunction, seizures, eye movement abnormalities, and other conditions. […] Following the studies of Panegyres, there has been an elaboration of the clinical phenomenology, diagnosis, and treatment of Whipple disease of the brain. […] Whipple disease of the brain may be fatal; patients may be left with residual amnesia, sleep orders, and eye movement abnormalities. […] Whipple disease should be considered in the differential diagnosis of rapidly progressive dementia, in the differential diagnosis of progressive supranuclear palsy, in isolated CNS lesions, and in the differential diagnosis of unusual eye movement disorders.

• #19 Whipple Disease: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/183350-overview

  Whipple disease is a systemic disease most likely caused by a gram-positive bacterium, Tropheryma whipplei (formerly T whippelii). […] The clinical manifestations of the disease are believed to be caused by infiltration of the various body tissues by T whipplei. […] The malabsorption observed in the small bowel that is associated with this condition is believed to be secondary to the disruption of normal villous function due to infiltration of the lamina propria of the small bowel. […] If Whipple disease is untreated, the prognosis is poor, and mortality approaches 100% after 1 year in patients who do not receive the correct diagnosis and therapy. […] If this condition is treated for a full year, the prognosis usually is good. Clinical remission occurs in approximately 70% of patients. […] Up to 30-40% of patients may relapse, and relapse appears to be more common in patients with central nervous system (CNS) related Whipple disease.

• #20 Whipple’s Disease – DoveMed

  https://www.dovemed.com/diseases-conditions/whipples-disease

  Cardiac symptoms: Pericarditis – inflammation of the sac-like covering, around the heart, Myocarditis – inflammation of the heart muscles, Injury in the valves […] Central nervous system related symptoms: Headache, confusion, dementia, Ophthalmoplegia – vision problems in lateral gaze, Myoclonus – sudden jerking of a muscle or a group of muscles, Oculomasticatory myorhythmia – unique movement disorder affecting the eyes and mouth muscles, Gait abnormalities – deviation from normal walking, Seizures, brain disorders, Coma, state of unconsciousness […] Ocular symptoms: Uveitis – swelling of the uvea, the middle layer of the eye, Vitritis – inflammation of the jelly, present in the rear side of the eye, Keratitis – inflammation of the cornea, in the front portion of the eye, Retinitis – inflammation of the retina, possibly leading to blindness, Retinal hemorrhages – eye disorder, where bleeding occurs in the back of the eye […] Pulmonary symptoms: Pleural effusion – accumulation of excess fluid around the lungs, Stretching of the mediastinum […] Other general symptoms include: Darkening of the skin, Chest pain, Mild fever, Chronic cough, Anemia and blood clotting related abnormalities.

• #21 Whipple disease: Symptoms, causes, and diagnosis

  https://www.medicalnewstoday.com/articles/188228

  Symptoms of Whipple vary widely among patients. The most common signs of the disease are weight loss and diarrhea. […] Other symptoms include: stomach pain, weakness, fatigue, anemia, a darkening or graying of skin exposed to the sun. […] Endocarditis has been reported in a small number of cases. Sometimes it is the only symptom of Whipple disease. Symptoms of endocarditis include breathlessness and swelling of the legs due to fluid buildup. The heart becomes inflamed and cannot pump fluid through the body. […] Whipple disease can progress to the central nervous system (CNS). If this occurs, a person begins to experience: insomnia, vision issues such as uveitis, hearing loss, dementia, memory problems and changes in personality, facial numbness, loss of mobility and difficulty walking, various eye problems may occur, such as uveitis. […] The disease at this stage can become fatal.

• #22 UNDERSTANDING WHIPPLE’S DISEASE: TRANSMISSION, SYMPTOMS, AND TREATMENT OPTIONS | Mya Care

  https://myacare.com/blog/understanding-whipples-disease-transmission-symptoms-and-treatment-options

  Whipple’s disease can have a widespread impact, affecting multiple systems and causing various symptoms. The symptoms may also only appear years after exposure to the organism. These factors can make diagnosing difficult, and the symptoms are often mistaken for other conditions. […] The most common symptoms of Whipple’s disease include: Weight loss, Diarrhea, Abdominal pain, Joint pain and stiffness, mimicking symptoms of arthritis (also known as arthralgia). […] Less prevalent manifestations comprise the following: Fever, Fatigue, Anemia, Skin hyperpigmentation, Enlargement of various organs, such as the lymph nodes, spleen, or liver. […] Whipple disease neurological symptoms are not as common, yet may also include: Dementia, including memory loss and confusion (reversible with treatment), Difficulty with coordination and balance, Vision changes, Headaches, Seizures, Muscle weakness, Numbness or tingling in the extremities.

• #23 Connecting the Dots: The Many Systemic Manifestations of Whipple Disease – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/january-2012/connecting-the-dots-the-many-systemic-manifestations-of-whipple-disease/

  Intermittent low-grade fever, fatigue, and generalized weakness are also common, and many other extraintestinal symptoms may occur. […] Central nervous system (CNS) involvement is common in Whipple disease; however, symptoms related to CNS Whipple disease may be present in a minority of patients. […] The most common CNS symptoms are dementia, paralysis of gaze, and myoclonus. […] In addition, there have been reports of stroke-like symptoms related to cerebral vasculitis from hematogenous spread of T. whipplei infection as well as recurrent embolic CVA secondary to T. whipplei endocarditis. […] Hyperpigmentation and peripheral lymphadenopathy are the most common physical findings and are seen in more than half of patients with Whipple disease. […] Laboratory abnormalities reflective of malabsorption—such as electrolyte disturbances, anemia secondary to chronic disease or iron deficiency, hypoalbuminemia, low serum carotene levels, and prolonged prothrombin time—are common in patients with Whipple disease.

• #24 Whipple disease | MedLink Neurology

  https://www.medlink.com/articles/whipple-disease

  The complete spectrum of neurologic and neuropsychiatric syndromes have been more fully delineated. […] Whipple disease may present with nonspecific uveitis, which may precede neurologic phenomena. […] The phenomenology has been extended to progressive dementia with ataxia or obesity and limbic encephalitis. […] A 30-year-old woman presented with headache associated with tingling and clumsiness of the left arm. […] A 46-year-old woman presented in November 2003 with generalized tonic-clonic seizures. […] A 41-year-old male metallurgist presented with the abrupt onset of continuous and involuntary twitching of the muscles of the left side of the face, which prevented him from sleeping. […] A 63-year-old man who was diagnosed with Whipple disease presented with abdominal pain, weight loss, dementia, ataxia, extrapyramidal features, falls, up-gaze palsy, oculomasticatory skeletal myorhythmia, and with unusual lesions of the skin and face.

• #25 Whipple’s disease of the respiratory system: A case report

  https://www.spandidos-publications.com/10.3892/etm.2024.12421

  Whipple’s disease (WD) is a multiplesystem chronic disease caused by Tropheryma whipplei (T. whipplei) infection. The present study describes 3 cases of WD with clinical manifestations of cough, chest pain, headache, dyspnea, sputum, joint pain, abdominal pain, diarrhea and weight loss. […] The imaging manifestations of WD lung involvement are also diverse, with the most common chest imaging manifestations being nodules, interstitial changes and patchy infiltrates, of which nodules are the most commonly observed, with cavitation-like changes, pleural thickening and pleural effusion being less common. […] Due to the heterogeneity of the clinical manifestations of the disease and the variety of imaging manifestations, there is a possibility that the disease may not be diagnosed and treated in a timely manner, leading to serious consequences or even mortalities.

• #26 Whipple’s disease of the respiratory system: A case report

  https://www.spandidos-publications.com/10.3892/etm.2024.12421

  In terms of clinical symptoms, all three patients had cough and sputum; two had chest pain; two had mixed headache manifestations; and one had fever and dyspnea that were thought to be associated with influenza A and bronchial asthma. […] The common clinical manifestations of the respiratory system are chest pain, dyspnea, chronic cough and phlegm. […] Clinical symptoms of WD improve significantly within a few days to weeks after treatment with antibiotics, but WD requires a certain period of maintenance therapy to prevent recurrence. […] Nevertheless, WD has a lifelong potential for relapse, and Lin et al suggested that the disease requires lifelong monitoring. […] The three patients with WD reported in the present study had their pathogens identified by mNGS.

• #27 What Is Whipple Disease? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/whipples-disease/guide/

  People who experience neurological symptoms are at a greater risk of experiencing negative health outcomes such as serious neurological problems and even death. […] If untreated, Whipple disease will progressively get worse and is most often fatal. […] Symptoms of Whipple disease can disappear about a month after antibiotic treatment. However, the disease can cause complications related to malnutrition as well as heart and brain-related problems that can last for a prolonged period of time. […] People whove had Whipple disease can also experience a relapse of symptoms, which can happen years after treatment.

• #28 Whipple’s disease – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/whipples-disease/diagnosis-treatment/drc-20378950

  Your symptoms should improve within one to two weeks of starting antibiotic treatment and go away entirely within about one month. […] But even though symptoms improve quickly, further lab tests may reveal the presence of the bacteria for two or more years after you begin taking antibiotics. […] Even after successful treatment, Whipple disease can recur.

• #29

  https://www.amerikanhastanesi.org/mayo-clinic-care-network/mayo-clinic-health-information-library/diseases-conditions/whipple-s-disease

  Your symptoms should improve within one to two weeks of starting antibiotic treatment and go away entirely within about one month. […] Even after successful treatment, Whipple disease can recur. Doctors usually advise regular checkups. If you’ve experienced a recurrence, you’ll need to repeat antibiotic therapy.

• #30 Whipple’s Disease – Wake Gastroenterology

  https://wakegastro.com/patient-info/patient-education/whipples-disease/

  Whipple’s disease is a malabsorption illness. It interferes with the body’s ability to absorb certain nutrients. The disease causes weight loss, incomplete breakdown of carbohydrates or fats, and malfunctions of the immune system, and it may affect the heart, lungs, brain, and eyes. […] Symptoms include diarrhea, intestinal bleeding, abdominal pain, loss of appetite, weight loss, fatigue, and weakness. Arthritis and fever often occur several years before intestinal symptoms develop. Patients may experience neurological symptoms as well. […] Full recovery of the small intestine may take up to 2 years, but the symptoms usually disappear in less time. Because relapse is common even after successful treatment, the health care team may continue to monitor the patient for many years.

• #31 CNS Whipple Disease | American Journal of Neuroradiology

  https://www.ajnr.org/ajnr-case-collections-diagnosis/cns-whipple-disease

  Signs/symptoms are primarily gastrointestinal and systemic, including malabsorption, diarrhea, weight loss, fever, and polyarthritis. […] CNS involvement occurs in a minority of patients and rarely without systemic involvement. […] Neurologic symptoms include cognitive changes, supranuclear gaze palsy, altered level of consciousness, psychiatric problems, and possible pathognomonic oculomasticatory or oculo-facial-skeletal myorhythmia. […] Treatment of CNS Whipple disease is with a combination of antibiotics. […] Symptoms should improve within 12 weeks of initiating antibiotic treatment, and most people with neurologic complications recover after a full course of antibiotics.

• #32 Whipple’s Disease: Symptoms and Causes | Doctor

  https://patient.info/doctor/whipples-disease

  Whipple’s disease may cause many different issues, due to the involvement of several organs. These include: […] Insidious progression and fatal if untreated. […] Locomotor and gastrointestinal symptoms may improve very rapidly with treatment but histological and microbiological remission can take several years. […] Follow up closely for signs of recurrence – there is relapse in about 40%.

• #33 SciELO Brazil – Whipple’s disease: rare disorder and late diagnosis Whipple’s disease: rare disorder and late diagnosis

  https://www.scielo.br/j/rimtsp/a/M6VVJ4WyhLgvZRvRHSQYGwb/?lang=en

  If not treated, Whipple’s disease can have a fatal outcome. Thus, the antibiotic selection was based on the fact that trimethoprim/sulfamethoxazole is an antibiotic that crosses the blood-brain barrier, with probability of being effective in the CNS involvement. […] Relapses of Whipple’s disease may appear several years after cessation of therapy, even when the initial treatment was considered effective. Even with an appropriate clinical treatment, there are reports of clinical relapse in about 2-33% of cases after a mean period of five years, and the CNS is the most frequent site involved.

• #34 Whipple’s disease – Wikipedia

  https://en.wikipedia.org/wiki/Whipple%27s_disease

  Whipple’s disease primarily causes malabsorption, but may affect any part of the human body, including the heart, brain, joints, skin, lungs and the eyes. Weight loss, diarrhea, joint pain, and arthritis are common presenting symptoms, but the presentation can be highly variable in certain individuals, and about 15% of patients do not have the standard signs and symptoms. […] The most common symptoms are diarrhea, abdominal pain, weight loss, and joint pains. The joint pains may be due to migratory nondeforming arthritis, which may occur many years before any digestive-tract symptoms develop; they tend to involve the large joints, but can occur in any pattern and tend not to damage the joint surface to the point that the joint becomes deformed. […] In its more advanced form, malabsorption (insufficient absorption of nutrients from the diet) leads to wasting and the enlargement of lymph nodes in the abdomen. Neurological symptoms (discussed below) are more common in those with the severe form of the abdominal disease.

• #35 Whipple’s Disease, One of Medicine’s Great Imitators: A Case Report – European Medical Journal

  https://www.emjreviews.com/flagship-journal/article/whipples-disease-one-of-medicines-great-imitators-a-case-report/

  The time to diagnosis from symptom onset in this case was approximately 18 months. […] This case demonstrates the importance of considering investigating for WD in patients who present with evidence of severe systemic inflammation, anaemia, or malabsorption of chronic duration, even if the cardinal symptoms of arthralgia, fever, or diarrhoea are not reported.

• #36 Rheumatological features of Whipple disease | Scientific Reports

  https://www.nature.com/articles/s41598-021-91671-9

  Whipple disease (WD) is a rare infectious systemic disease. An early diagnosis is crucial, as usual anti-rheumatic drugs, especially TNF inhibitors, may worsen the disease course. Classic Whipple disease (CWD) is characterized by the association of nonspecific gastrointestinal symptoms, such as abdominal pain, chronic diarrhoea and weight loss, with articular symptoms, which usually precede the digestive symptoms by several years. Other systemic features may coexist, such as general symptoms (fever, asthenia), cardiac involvement with the occurrence of culture-negative endocarditis, pleural effusion or pericarditis, and sometimes uveitis or a host of nonspecific neurological symptoms (from headache and memory loss to encephalitis and pathognomonic oculomasticatory myorhythmia). More digestive symptoms and systemic biological features were observed in CWD patients than in NCWD patients, but both patient groups had similar outcomes, especially concerning the response to antibiotics and relapse rate. All patients but one presented rheumatological symptoms. Specific rheumatological features are presented in Table 2. Forty-two patients (62%) exclusively had peripheral involvement, while 26 patients (38%) had axial+/ peripheral involvement. Arthritis occurred in 60 patients (88%), inflammatory arthralgia occurred in 62 patients (91%), and inflammatory back pain occurred in 25 patients (37%). Oligoarticular and polyarticular involvement were seen in 48% and 44% of our population, respectively. Palindromic rheumatism was observed in 42 patients, with a trend towards more intermittent presentation in LWD (90%), AWD (92%) and PAWD (67%) than in CWD (50%). The disease evolution after antibiotic treatment is presented in Supplementary Table S5. None of the 68 patients had resistance to antibiotic treatment, with a rapid relief of symptoms and inflammatory syndrome resolution. At the end of antibiotic treatment, 36/43 tested patients had negative PCR results (84%). Relapses occurred in 21/65 patients (32%). Seven patients in the cohort evolved towards chronic rheumatism, all at least one year after antibiotic treatment initiation: 2 with CWD, 1 with LWA and 4 with AWD/PAWD.

• #37

  https://reu.termedia.pl/Clinical-manifestations-of-Whipple-s-disease-mimicking-rheumatic-disorders,135319,0,2.html

  Whipples disease is a rare, chronic, systemic disorder caused by Tropheryma whipplei infection. The most common symptoms are weight loss, arthralgia, diarrhea and abdominal pain. Other organ involvement can also occur in the patients. Joint manifestations may mimic rheumatoid arthritis or spondyloarthritis. Arthalgia, arthritis, spondylodiscitis, bursitis and/or tenosynovitis are seen in the majority of the patients. This explains why some of the symptoms are misdiagnosed as those of rheumatic diseases. Understanding of Whipples disease is important for differential diagnostics of several rheumatic symptoms.

• #38 Whipple disease

  https://dermnetnz.org/topics/whipple-disease

  Whipple disease is typically described in Caucasian men with a mean age of 50 years at the time of diagnosis. […] The symptoms of Whipple disease are related to the immune system and its interaction with the bacterium. […] The four classic clinical features of Whipple disease are: Arthralgia (joint pain), Weight loss, Diarrhoea due to malabsorption (inability to absorb nutrients through the gastrointestinal tract), Abdominal pain. […] However, Whipple disease can affect any organ system and has a broad spectrum of clinical features. […] After treatment, a 4-5 year (or longer) period of latency may ensue before recurrence in 10-15% if the infection is not completely eradicated particularly in patients with CNS involvement.

• #39 Whipple disease – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/467

  Affected patients are typically middle-aged white men, who may present with weight loss, arthralgia, diarrhea, and fever. […] Patients are typically middle-aged white men, who present with arthralgia, weight loss, diarrhea, and fever. […] Key diagnostic factors include diarrhea, weight loss, arthralgia, and supranuclear ophthalmoplegia. […] Other diagnostic factors include abdominal pain, lymphadenopathy, fever, steatorrhea, anemia, skin darkening, confusion, memory impairment, altered level of consciousness, or dementia, apathy, anxiety, depression, hypomania, psychosis, change in personality, myoclonic signs, seizures, nystagmus, brisk reflexes, extensor plantar responses, weakness predominating in arm extensors and leg flexors, hypertonia, amenorrhea, polydipsia, hyperphagia, decreased libido, ataxia, headaches, oculomasticatory and oculofacioskeletal myorhythmias, hemiparesis, cranial nerve involvement, extrapyramidal movement disorder, and peripheral neuropathies.

• #40

  https://journals.lww.com/ajg/fulltext/2014/10002/whipple_s_disease__a_fatal_disease_that_is_often.1066.aspx

  Whipples disease is a potentially fatal condition that is usually missed. […] Whipples disease is a chronic systemic infection due to Tropheryma whipplei that commonly manifests itself through gastrointestinal symptoms of malabsorption. It is a potentially fatal condition that is usually missed due to its rarity and nonspecific symptoms. The disease has a prodromal stage noticeable for arthralgia and arthritis followed by a steady state stage remarkable for diarrhea and weight loss. The average time between the 2 stages is 6 years, but immunosuppressive therapy can expedite clinical progression. […] Medical providers should be attentive to consider Whipples disease in patients with abdominal and joint symptoms after omitting common diseases, especially if symptoms are refractory to treatment.

• #41 Whipple disease | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/whipple-disease?lang=us

  Patients often present with a non-destructive migratory arthritis, weight loss, diarrhea and abdominal pain. Less commonly patients present with fever, lymphadenopathy or hepatosplenomegaly. […] The presence of arthritis may precede other symptoms by years. […] CNS involvement with Whipple disease carries a poor prognosis and is invariably fatal without treatment. Approximately half of the patients may show some symptomatic improvement during antibiotic treatment. ~17.5% (range 2-33%) patients may relapse. Thus, early diagnosis and treatment are paramount for survival.

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