What are the symptoms of Whipple's disease?

From the Guidelines

Whipple's disease typically presents with symptoms such as diarrhea, weight loss, joint pain, and abdominal pain, which can develop gradually over time. The classic symptoms of Whipple's disease include chronic diarrhea, which may be watery or fatty (steatorrhea), leading to significant weight loss due to malabsorption of nutrients 1. Joint pain, particularly in the knees, ankles, and wrists, can precede other symptoms by years. Additional symptoms include fever, fatigue, weakness, and enlarged lymph nodes. As the disease progresses, neurological symptoms may develop, including confusion, memory problems, vision changes, and abnormal eye movements. Some patients also experience skin darkening (hyperpigmentation), heart valve problems, or chronic cough. Whipple's disease is caused by the bacterium Tropheryma whipplei and primarily affects middle-aged men. The disease is rare but serious, and without treatment, it can be fatal. Diagnosis typically requires intestinal biopsy showing PAS-positive macrophages containing the bacteria. Early recognition of these symptoms is crucial for prompt diagnosis and antibiotic treatment.

Some of the key symptoms of Whipple's disease include:

• Diarrhea
• Weight loss
• Joint pain
• Abdominal pain
• Fever
• Fatigue
• Weakness
• Enlarged lymph nodes
• Neurological symptoms such as confusion, memory problems, vision changes, and abnormal eye movements
• Skin darkening (hyperpigmentation)
• Heart valve problems
• Chronic cough

It is essential to note that Whipple's disease can be fatal if left untreated, and early recognition of these symptoms is crucial for prompt diagnosis and antibiotic treatment, which usually consists of initial intravenous ceftriaxone followed by long-term oral trimethoprim-sulfamethoxazole 1. However, other treatment options, such as doxycycline plus hydroxychloroquine, have also been reported to be effective in some cases 1.

From the Research

Symptoms of Whipple's Disease

The symptoms of Whipple's disease are varied and can be divided into several categories:

• Gastrointestinal symptoms:
  • Diarrhea 2, 3, 4
  • Abdominal pain 2, 3, 4
  • Weight loss 2, 5, 3, 4
  • Anorexia 3
  • Constipation (in rare cases) 6
  • Digestive bleeding (in rare cases) 6
• Joint and muscle symptoms:
  • Arthralgias (joint pain) 2, 5, 3, 4
  • Migratory arthralgia 3
• Neurological symptoms:
  • Dementia 2
  • Abnormalities of eye movements 2
  • Involuntary movements 2
  • Seizures 2
  • Hypothalamic dysfunction 2
  • Myelopathy 2
  • Ataxia 2
  • Psychiatric manifestations 2
• Other symptoms:
  • Fever 2, 5, 3, 4
  • Lymphadenopathies (enlarged lymph nodes) 2
  • Uveitis (inflammation of the eye) 2
  • Retinitis (inflammation of the retina) 2
  • Optic neuritis (inflammation of the optic nerve) 2
  • Papilloedema (swelling of the optic disc) 2
  • Fatigue 3
  • Loss of appetite 4
  • Asthenia (weakness) 4