Whipple's disease physical examination
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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]
Overview
Patients with Whipple's disease usually appear weak. Physical examination of patients with Whipple's disease is usually remarkable for weight loss and joint pain. Further physical findings depend on the systems involved by the disease.
Physical Examination
- Physical examination of patients with Whipple's disease is usually remarkable for generalised weakness secondary to weight loss and joint pain in peripheral joints.
- The presence of eye findings namely Oculomasticatory, or oculofacialskeletal, myorhythmia are pathognomic.
Appearance of the Patient
- Patients with Whipple's disease may appear weak and tired some times severe enough to cause cachexia secondary to malabsorption and weight loss.
Vital Signs
- Low-grade intermittent fever may be present in some patients. it might be associated with night sweats [1]
Skin
- Hyperpigmentation may be present in some patients. It is more frequent in sun exposed areas. [1]
- Some patients may develop skin nodules
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Description (Adapted from Dermatology Atlas)
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Description (Adapted from Dermatology Atlas)
HEENT
- Nystagmus
- Extra-ocular movements may be abnormal. Oculomasticatory, or oculofacialskeletal, myorhythmia are pathognomic. [1]
Neck
- Lymphadenopathy is common. Peripheral lymph nodes may be palpable. [1]
Lungs
- In patients who develop pleural effusion lungs are hyporesonant
- There may be asymmetrical chest expansion.
- Distant breath sounds
- Reduced tactile fremitus
Heart
- A systolic murmur may be heard in patients with cardiac valve involvement. [1]
Abdomen
- Abdominal bloating and cramps may be compained by some patients. [1]
- hepatosplenomegaly may be seen in some patients
Neuromuscular
- Patient may be asymptomatic or may have cognitive changes [1]
- Patient may have altered level of consciousness [1]
- Some patients may present with seizure[1]
- Myoclonus may be present
- Ataxia may be present [1]
Extremities
- Arthralgia of peripheral joints can be frequently seen
- Joint deformity with Whipple's disease is extremely rare