title: An atypical case of neuro-Whipple: Clinical presentation, magnetic resonance spectroscopy and follow-up.
abstract: We report a case of a 53-year-old man with a 2-year history of progressive gait and balance disturbance, supranuclear ophthalmoparesis, mild dysarthria and dysmetria. EMG revealed a lower limb axonal sensory-motor neuropathy, while MR imaging demonstrated a small focal lesion in the right frontal lobe, mild diffuse hyperintensity of the periventricular white matter and diffuse brain atrophy. Magnetic resonance spectroscopy revealed a mild decrease in N-acetyl-aspartate peak and an increase in the choline peak in the small right frontal lesion and within 6 voxels of interest in normal appearing cerebral tissue. According to the clinical picture the diagnosis of WD was made by the positivity of PCR for T. whipplei DNA on CSF. After treatment the patient showed a mild clinical improvement although MR images and laboratory test remained unchanged. The MRS findings suggest that the pathological process of the disease diffusely involves the brain. Despite the absence of gastrointestinal involvement WD should be suspected in all complex and atypical neurological pictures, even in presence of peripheral involvement, in order to be able to start treatment promptly.
authors.affiliation: Department of Neurology and Otolaryngology, Sapienza University of Rome, Italy. caterina.pauletti@libero.it
authors.forename: Caterina
authors.initials: C
authors.lastname: Pauletti
authors.forename: Francesco
authors.initials: F
authors.lastname: Pujia
authors.forename: Massimo
authors.initials: M
authors.lastname: Accorinti
authors.forename: Flavia
authors.initials: F
authors.lastname: Pauri
authors.forename: Emanuele
authors.initials: E
authors.lastname: Tinelli
authors.forename: Federico
authors.initials: F
authors.lastname: Bianco
authors.forename: Cristoforo
authors.initials: C
authors.lastname: Morocutti
authors.forename: Francesco
authors.initials: F
authors.lastname: Fattapposta
mesh_terms: D001927:Brain Diseases / Q000209:etiology* / Q000378:metabolism* / Q000382:microbiology / Q000473:pathology; D002794:Choline / Q000378:metabolism; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D054851:Tropheryma / Q000235:genetics / Q000472:pathogenicity; D008061:Whipple Disease / Q000150:complications* / Q000378:metabolism* / Q000473:pathology
chemical_list: D002794:Choline