Sunday, 14 November 2010

MRCP revision battle 49.4: Whipples disease

Whipple's disease is a rare cause of GI malabsorption.  It is caused by a gram positive bacterium Tropheryma whippelei.

Presentation is:
  • weight loss
  • arthralgia
  • diarrhoea
  • malaise
  • fever

Other symptoms may occur in relation to the malabsorption, for example signs of hypocalcaemia or vitamin C deficiency.

Possible clinical signs include:
• lymphadenopathy
• perioral hyperpigmentation

Cardiac involvement can result in an endocarditis, and CNS involvement can cause a reversible dementia.

It is commonest in males (9:1) and is associated with HLA B27.

Treatment is 2 weeks IV ceftriaxone then oral co-trimoxazole for one year.

Now for some excess magnesium...