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]; Sadaf Sharfaei M.D.[3]
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 in the disease.
Physical Examination
- Physical examination of patients with Whipple's disease is usually remarkable for generalized weakness secondary to weight loss.
- The presence of eye findings namely oculomasticatory, or oculofacialskeletal, myorhythmia are pathognomic.
Appearance of the Patient
- Patients with Whipple's disease usually appear tired and weak.
Vital Signs
- Low-grade intermittent fever
Skin
- Pallor
- Hyperpigmentation: more frequent in sun exposed areas.[1]
- Skin nodules
HEENT
- Nystagmus
- Abnormal extra-ocular movements
- Oculomasticatory (pathognomic)
- Oculofacialskeletal (pathognomic)
- Myorhythmia (pathognomic)
Neck
- Lymphadenopathy (common in peripheral lymph nodes)
Lungs
- In patients who develop pleural effusion, may have:
- Asymmetrical chest expansion
- Lungs are hyporesonant
- Distant breath sounds
- Reduced tactile fremitus
Heart
- systolic murmur with cardiac valve involvement. [1]
Abdomen
- Abdominal bloating and cramps . [1]
- hepatosplenomegaly
Neuromuscular
- May be asymptomatic
- May have cognitive changes [1]
- Altered level of consciousness [1]
- Seizure[1]
- Myoclonus
- Ataxia [1]
Extremities
- Arthralgia of peripheral joints : frequently seen
- Joint deformity with Whipple's disease is extremely rare