Whipple's disease history and symptoms

Patients with Whipple’s disease have various presentations. Most common symptoms of the classic Whipple’s disease include joint pain, weight loss, diarrhea, and abdominal pain. Other organ systems can be involved in Whipple’s disease including central nervous system, cardiac system, renal system, skeletal, muscles and pulmonary system.

Obtaining history is important to find risk factors for the Whipple’s disease. Other differentials specifically those which cause malabsorption must be ruled out. Specific areas of focus when obtaining the history, are outlined below:^{[1][2][3][4][5][6][7][8][9][10][11][12]}

• Onset, duration and progression of symptoms
• History of consuming contaminated water or vegetables
• History of access to proper sanitation and toilets
• History of living in shelters
• History of similar symptoms in a family
• Medical history of immunosuppression therapy
• History of HIV infection

Whipple’s disease is a systemic disease that involves multiple organs. Many of the patients present with gastrointestinal symptoms, while others presents with localized involvement of different organs.^{[1][2][3][4][5][6][7][8][9][10][11][12]}

• Fever
• Weight loss
• Fatigue
• Night sweats

• Diarrhea: The most common complaint
• Steatorrhea
• Abdominal pain
• Edema

• Intermittent migratory arthralgias: The second most common complaint
• Arthritis affecting peripheral joints, such as knees, elbows, wrists, and shoulders
• Multiple joint involvement

• Asymptomatic involvement with detection of Tropheryma whipplei DNA in CSF: The most common finding
• Focal CNS involvement:
  • Forgetfulness
  • Hemiparesis
  • Personality changes
  • Progressive cognitive decline
  • Nystagmus
  • Twitching of a muscle 
• Hypothalamic involvement (rarely)
  • Polydipsia
  • Hyperphagia
  • Change in libido
  • Change in sleep wake cycle
• Eye movement abnormalities (pathognomic)
• CNS involvement usually has poor prognosis.

Ocular involvement is rare and is often seen in patients with CNS disease. It can involve:

• Eye pain
• Eye redness
• Decreased vision
• Diplopia

• Myalgia
• Muscle cramps

• Chest pain: It could be pleuritic
• Shortness of breath
• Palpitations
• Chronic cough
• Cyanosis
• Sudden cardiac death

• Skin color changes
• Yellowish discoloration of the skin

• Renal involvement is late in course, may be seen rarely.

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