Whipple's disease with destructive arthritis, abdominal lymphadenopathy, and central nervous system involvement.
We describe a patient with Whipple's disease who had an unusual erosive and destructive polyarthritis, massive abdominal lymphadenopathy, asymptomatic central nervous system involvement, and rare manifestations of orbital pseudotumor and orchitis with epididymitis. Taking oral therapy with trimethoprim-sulfamethoxazole he had recurrent flares of orbital pseudotumor, an episode of orchitis with epididymitis, and persistent polymerase chain reaction T. whipplei-positive cerebrospinal fluid. Resolution was achieved with a one month course of intravenous ceftriaxone and a 6 month course of azithromycin, and no relapse occurred during 24 months of followup.
Dearment
Michael C
MC
Division of Pulmonary Medicine, Mayo Clinic, Jacksonville, Florida 32224, USA.
Woodward
Timothy A
TA
Menke
David M
DM
Brazis
Paul W
PW
Bancroft
Laura W
LW
Persellin
Scott T
ST
D000005:Abdomen; D001168:Arthritis / Q000000981:diagnostic imaging / Q000382:microbiology*; D001927:Brain Diseases / Q000382:microbiology*; D004823:Epididymitis / Q000382:microbiology; D006801:Humans; D008206:Lymphatic Diseases / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009920:Orchitis / Q000382:microbiology; D011859:Radiography; D008061:Whipple Disease / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging