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| __NOTOC__
| | ==pic== |
| {{Whipple's disease}} | | {| |
| {{CMG}};{{AE}}{{BHA}}
| | |[[image:LowKECG.png|thumb|700px|center|An ECG in a person with a potassium level of 1.1 showing the classical ECG changes of ST segment depression, inverted T waves, large U waves, and a slightly prolonged PR interval. By James Heilman, MD - Own work, CC BY-SA 3.0]] |
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| ==Overview==
| | [[image:LowKECG.png|thumb|700px|right|An ECG in a person with a potassium level of 1.1 showing the classical ECG changes of ST segment depression, inverted T waves, large U waves, and a slightly prolonged PR interval. By James Heilman, MD - Own work, CC BY-SA 3.0]] |
| Patients with Whipple's disease have varied presentation. Most common symptoms of the classical Whipple's disease include [[joint pain]], [[weight loss]], [[diarrhea]], and [[arthropathy]]. Other organ systems can be involved in Whipple's disease including [[central nervous system]], [[cardiac]] system, [[renal]] system, [[skeletal]], [[muscles]] and [[pulmonary]] system.
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| ==History and Symptoms==
| | {{#ev:youtube|7TWu0_Gklzo}} |
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| == Common Symptoms == | | ==Table== |
| | | {| |
| ==== Non specific symptoms ====
| | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Complications |
| * [[Fever]]
| | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Polymyositis |
| * [[Weight loss]]
| | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dermatomyositis |
| | | |- |
| ====Gastrointestinal system====
| | ! align="center" style="background:#DCDCDC;" + |[[Cancer|Malignancy]] |
| * [[Diarrhea]]: The most common complaint
| | | align="left" style="background:#F5F5F5;" + | |
| * [[Steatorrhea]]
| | *[[Lung]] |
| * [[Abdominal pain]]
| | | align="center" style="background:#F5F5F5;" + | |
| * Occult [[mucosal bleeding]]
| | *[[Lung]] |
| * [[Ascites]]
| | |} |
| * [[Hepatosplenomegaly]]
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| * [[Hepatitis]]
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| ====Articular system====
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| * Intermittent migratory [[arthralgias]]: The second most common complaint
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| * [[arthritis]]: Affecting peripheral joints, such as [[knees]], [[elbows]], [[wrists]]
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| * Multiple [[joint]] involvement
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| == Less Common Symptoms ==
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| '''Central nervous system'''
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| * Asymptomatic involvement with detection of [[Tropheryma whipplei]] [[DNA]] in [[CSF]]: The most common finding
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| * Focal CNS involvement:
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| ** [[dementia]]
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| ** [[cerebral ataxia]]
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| ** [[hemiparesis]]
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| ** [[Personality changes]]
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| ** [[opthalmoplegia]]
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| ** [[nystagmus]]
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| ** Supranuclear opthalmoplegia (50% of patients)
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| ** [[myoclonus]] (25% of patients)
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| * [[Hypothalamic]] involvement (rarely)
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| ** P[[polydipsia|olydipsia]]
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| ** [[hyperphagia]]
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| ** Change in [[libido]]
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| ** Change in sleep wake cycle
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| * [[Eye movements|Eye movement]] abnormalities (pathognomic)
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| ** Oculomasticatory myorhythmia (OMM)
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| ** Oculofacial-skeletal myorhythmia (OSFM)
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| * CNS involvement usually has poor prognosis.<ref name="pmid17202456">{{cite journal| author=Fenollar F, Puéchal X, Raoult D| title=Whipple's disease. | journal=N Engl J Med | year= 2007 | volume= 356 | issue= 1 | pages= 55-66 | pmid=17202456 | doi=10.1056/NEJMra062477 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17202456 }} </ref><ref name="pmid11432814">{{cite journal| author=Dutly F, Altwegg M| title=Whipple's disease and "Tropheryma whippelii". | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 3 | pages= 561-83 | pmid=11432814 | doi=10.1128/CMR.14.3.561-583.2001 | pmc=88990 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11432814 }} </ref>
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| '''Ocular involvement'''
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| rare and can involve: <ref name="pmid11432814" />
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| * [[uveitis]],
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| * [[retinitis]] ,
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| * [[vitritis]]
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| * [[retrobulbar neuritis]]
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| * [[papilledema]] .
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| * Ocular involvement is often seen in patients with CNS disease. <ref name="pmid11432814">{{cite journal| author=Dutly F, Altwegg M| title=Whipple's disease and "Tropheryma whippelii". | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 3 | pages= 561-83 | pmid=11432814 | doi=10.1128/CMR.14.3.561-583.2001 | pmc=88990 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11432814 }} </ref>
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| '''Skeletal muscle''' '''involvement'''
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| * seen as [[myalgias]] and muscle cramps <ref name="pmid17202456">{{cite journal| author=Fenollar F, Puéchal X, Raoult D| title=Whipple's disease. | journal=N Engl J Med | year= 2007 | volume= 356 | issue= 1 | pages= 55-66 | pmid=17202456 | doi=10.1056/NEJMra062477 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17202456 }} </ref>
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| '''Cardiac involvement''' :may have varied presentation .<ref name="pmid17202456" /> <ref name="pmid11432814" />
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| * [[pericarditis]]
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| * [[myocarditis]]
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| * [[heart failure]]
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| * [[sudden Cardiac death]]
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| * [[Endocarditis]] : associated with negative blood cultures. Endocarditis is often preceded by [[arthritis]] and [[arthralgias]] .<ref name="pmid17202456">{{cite journal| author=Fenollar F, Puéchal X, Raoult D| title=Whipple's disease. | journal=N Engl J Med | year= 2007 | volume= 356 | issue= 1 | pages= 55-66 | pmid=17202456 | doi=10.1056/NEJMra062477 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17202456 }} </ref> <ref name="pmid11432814">{{cite journal| author=Dutly F, Altwegg M| title=Whipple's disease and "Tropheryma whippelii". | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 3 | pages= 561-83 | pmid=11432814 | doi=10.1128/CMR.14.3.561-583.2001 | pmc=88990 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11432814 }} </ref>
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| '''Pulmonary involvement <ref name="pmid11432814" />'''
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| * manifest as pleuritic chest pain
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| * non productive cough
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| * [[dyspnea]] | |
| * Chest x-ray often shows [[pleural effusion]] , pulmonary infiltration, or granulomatous mediastinal adenopathy. Often abdominal lymph nodes may be involved.
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| '''Hematological finding'''
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| * [[anemia]] which may be due to malabsorption or mucointestinal bleeding.<ref name="pmid11432814">{{cite journal| author=Dutly F, Altwegg M| title=Whipple's disease and "Tropheryma whippelii". | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 3 | pages= 561-83 | pmid=11432814 | doi=10.1128/CMR.14.3.561-583.2001 | pmc=88990 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11432814 }} </ref>
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| '''Cutaneous finding'''
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| * [[melanoderma]] : less frequently reported these days as Whipple's disease is increasingly recognized early. <ref name="pmid17202456">{{cite journal| author=Fenollar F, Puéchal X, Raoult D| title=Whipple's disease. | journal=N Engl J Med | year= 2007 | volume= 356 | issue= 1 | pages= 55-66 | pmid=17202456 | doi=10.1056/NEJMra062477 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17202456 }} </ref> | |
| '''Renal involvemen'''t : late in course, may be seen rarely. <ref name="pmid17202456">{{cite journal| author=Fenollar F, Puéchal X, Raoult D| title=Whipple's disease. | journal=N Engl J Med | year= 2007 | volume= 356 | issue= 1 | pages= 55-66 | pmid=17202456 | doi=10.1056/NEJMra062477 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17202456 }} </ref>
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| ==References==
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| {{Reflist|2}}
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| {{WH}}
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| {{WS}}
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