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Journal of General Internal Medicine

, Volume 23, Issue 12, pp 2131–2133 | Cite as

Whipple’s Disease: Neurological Relapse Presenting as Headache for Two Years

  • Anuritha R. Marumganti
  • Timothy F. Murphy
Case Reports/Clinical Vignettes

ABSTRACT

Whipple’s disease is a rare, chronic, multi-systemic infectious disorder caused by the bacterium, Tropheryma whipplei. Relapses are commonly associated with neurological symptoms. We report a case of a 55-year-old man who presented with symptoms of progressive headache, 13 years after apparent complete recovery from intestinal Whipple’s disease. Studies showed hydrocephalus with obstruction of the aqueduct and cerebrospinal fluid findings consistent with chronic meningitis. Diagnosis of central nervous system Whipple’s disease was confirmed by analysis of the cerebrospinal fluid using polymerase chain reaction. After one year of antibiotic therapy, symptoms resolved and cerebrospinal fluid pleocytosis had improved. This case illustrates that Whipple’s disease should be included in the differential diagnosis of central nervous system disorders as it is a potentially treatable cause of chronic meningitis. Failure to recognize this presentation can lead to misdiagnosis or a significant delay in diagnosis and treatment.

KEY WORDS

Tropheryma whipplei headache cerebrospinal fluid polymerase chain reaction 

Notes

Acknowledgments

No financial support for the authors related to this case.

Conflict of Interest Statement

None disclosed.

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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  1. 1.University at Buffalo, State University of New York, Internal Medicine Residency ProgramBuffaloUSA
  2. 2.Department of Internal MedicineUniversity at Buffalo, State University of New YorkBuffaloUSA
  3. 3.Veterans Affairs Western New York Healthcare SystemBuffaloUSA

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