Whipple's disease history and symptoms: Difference between revisions
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==History and Symptoms== | ==History and Symptoms== | ||
Whipple's disease is a systemic disease that involves multiple [[organs]]. Many of the patients present with [[gastrointestinal]] symptoms, while others presents with localized involvement of different [[organs]]. | Whipple's disease is a systemic disease that involves multiple [[organs]]. Many of the patients present with [[gastrointestinal]] symptoms, while others presents with localized involvement of different [[organs]].<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><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> | ||
== Common Symptoms == | == Common Symptoms == | ||
==== Non specific symptoms ==== | ==== Non specific symptoms ==== | ||
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** Oculomasticatory myorhythmia (OMM) | ** Oculomasticatory myorhythmia (OMM) | ||
** Oculofacial-skeletal myorhythmia (OSFM) | ** Oculofacial-skeletal myorhythmia (OSFM) | ||
* CNS involvement usually has poor prognosis. | * CNS involvement usually has poor prognosis. | ||
====Ocular involvement==== | ====Ocular involvement==== | ||
Ocular involvement is rare and can involve: | Ocular involvement is rare and can involve: | ||
* [[Uveitis]] | * [[Uveitis]] | ||
* [[Retinitis]] | * [[Retinitis]] | ||
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* [[Retrobulbar neuritis]] | * [[Retrobulbar neuritis]] | ||
* [[Papilledema]] . | * [[Papilledema]] . | ||
* [[Ocular]] involvement is often seen in patients with [[CNS]] disease. | * [[Ocular]] involvement is often seen in patients with [[CNS]] disease. | ||
====Skeletal muscle involvement==== | ====Skeletal muscle involvement==== | ||
* [[Myalgia]] | * [[Myalgia]] | ||
* [[Muscle cramps]] | * [[Muscle cramps]] | ||
====Cardiac involvement==== | ====Cardiac involvement==== | ||
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* [[Congestive heart failure]] | * [[Congestive heart failure]] | ||
* [[Sudden cardiac death]] | * [[Sudden cardiac death]] | ||
* [[Endocarditis]] associated with negative [[blood cultures]]. [[Endocarditis]] is often preceded by [[arthritis]] and [[arthralgias]]. | * [[Endocarditis]] associated with negative [[blood cultures]]. [[Endocarditis]] is often preceded by [[arthritis]] and [[arthralgias]]. | ||
====Pulmonary involvement==== | ====Pulmonary involvement==== | ||
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====Cutaneous finding==== | ====Cutaneous finding==== | ||
* [[Melanoderma]]: less frequently reported these days as Whipple's disease is increasingly recognized early. | * [[Melanoderma]]: less frequently reported these days as Whipple's disease is increasingly recognized early. | ||
====Renal involvement==== | ====Renal involvement==== | ||
Renal involvement is late in course, may be seen rarely. | Renal involvement is late in course, may be seen rarely. | ||
==References== | ==References== |
Revision as of 20:37, 9 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Bhagyashree Deshmankar M.B.B.S.[2]; Sadaf Sharfaei M.D.[3]
Overview
Patients with Whipple's disease have various presentations. Most common symptoms of the classic 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.
History and Symptoms
Whipple's disease is a systemic disease that involves multiple organs. Many of the patients present with gastrointestinal symptoms, while others presents with localized involvement of different organs.[1][2]
Common Symptoms
Non specific symptoms
Gastrointestinal system
- Diarrhea: The most common complaint
- Steatorrhea
- Abdominal pain
- Occult mucosal bleeding
- Ascites
- Hepatosplenomegaly
- Hepatitis
Articular system
- Intermittent migratory arthralgias: The second most common complaint
- Arthritis affecting peripheral joints, such as knees, elbows, wrists, and shoulders
- Multiple joint involvement
Less Common Symptoms
Central nervous system
- Asymptomatic involvement with detection of Tropheryma whipplei DNA in CSF: The most common finding
- Focal CNS involvement:
- Dementia
- Cerebral ataxia
- Hemiparesis
- Personality changes
- Opthalmoplegia
- Nystagmus
- Supranuclear opthalmoplegia (50% of patients)
- Myoclonus (25% of patients)
- Hypothalamic involvement (rarely)
- Polydipsia
- Hyperphagia
- Change in libido
- Change in sleep wake cycle
- Eye movement abnormalities (pathognomic)
- Oculomasticatory myorhythmia (OMM)
- Oculofacial-skeletal myorhythmia (OSFM)
- CNS involvement usually has poor prognosis.
Ocular involvement
Ocular involvement is rare and can involve:
- Uveitis
- Retinitis
- Vitritis
- Retrobulbar neuritis
- Papilledema .
- Ocular involvement is often seen in patients with CNS disease.
Skeletal muscle involvement
Cardiac involvement
- Pericarditis
- Myocarditis
- Congestive heart failure
- Sudden cardiac death
- Endocarditis associated with negative blood cultures. Endocarditis is often preceded by arthritis and arthralgias.
Pulmonary involvement
- Pleuritic chest pain
- Chronic cough
- Dyspnea
- Chest x-ray often shows pleural effusion , pulmonary infiltration, or granulomatous mediastinal adenopathy. Often abdominal lymph nodes may be involved.
Cutaneous finding
- Melanoderma: less frequently reported these days as Whipple's disease is increasingly recognized early.
Renal involvement
Renal involvement is late in course, may be seen rarely.
References
- ↑ Dutly F, Altwegg M (2001). "Whipple's disease and "Tropheryma whippelii"". Clin Microbiol Rev. 14 (3): 561–83. doi:10.1128/CMR.14.3.561-583.2001. PMC 88990. PMID 11432814.
- ↑ Fenollar F, Puéchal X, Raoult D (2007). "Whipple's disease". N Engl J Med. 356 (1): 55–66. doi:10.1056/NEJMra062477. PMID 17202456.