title: Central nervous system relapse of Whipple's disease.
abstract: A 50-year-old man presented with a 12 kg weight loss in 8 months. Upper gastrointestinal endoscopy findings showed strong erosion and diffuse bleeding in the duodenum. Histopathological findings showed PAS staining-positive macrophages consistent with Whipple's disease. He was treated with trimethoprim-sulfamethoxazole. His condition initially improved. However, during his 6-year course of treatment he developed a central nervous system relapse. Tropheryma whipplei DNA was detected by a polymerase chain reaction in his cerebrospinal fluid. This relapse was successfully treated with ceftriaxone sodium (CTRX). We considered that as initial therapy for Whipple's disease, it would be important to administer CTRX for at least a few months, due to its high translatability to CSF.
authors.affiliation: Department of Respiratory Medicine, Yao Tokushukai General Hospital, Japan. kiyoaki2377@yahoo.co.jp
authors.forename: Kiyoaki
authors.initials: K
authors.lastname: Uryu
authors.forename: Takashi
authors.initials: T
authors.lastname: Sakai
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Takahito
authors.initials: T
authors.lastname: Mae
authors.forename: Yoshie Iwasaki
authors.initials: YI
authors.lastname: Willard
authors.forename: Hiroji
authors.initials: H
authors.lastname: Sugita
authors.forename: Koukichi
authors.initials: K
authors.lastname: Asano
authors.forename: Kenichi
authors.initials: K
authors.lastname: Yamashita
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Harada
authors.forename: Kou
authors.initials: K
authors.lastname: Fukuda
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D020806:Central Nervous System Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D054851:Tropheryma / Q000235:genetics / Q000302:isolation & purification; D008061:Whipple Disease / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D015662:Trimethoprim, Sulfamethoxazole Drug Combination