title: Whipple's disease: neurological relapse presenting as headache for two years.
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.
authors.affiliation: Internal Medicine Residency Program, State University of New York, University at Buffalo, Buffalo, NY, USA.
authors.forename: Anuritha R
authors.initials: AR
authors.lastname: Marumganti
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Murphy
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002493:Central Nervous System Diseases / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000188:drug therapy; D003937:Diagnosis, Differential; D006261:Headache / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D055502:Secondary Prevention; D008061:Whipple Disease / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents
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