Whipple's disease physical examination

Patients with Whipple’s disease usually appear weak. Physical examination of patients with Whipple’s disease is usually remarkable for weight loss and signs of vitamin deficiency. Further physical findings depend on the systems involved in the disease. Abnormal eye movements including oculomasticatory myorhythmia, or oculofacial-skeletal myorhythmia are pathognomonic for the Whipple’s disease.

• Physical examination of patients with Whipple’s disease is usually remarkable for generalized weakness secondary to weight loss.^{[1][2][3][4][5][6][7][8][9][10][11][12]}

• The presence of eye findings namely oculomasticatory myorhythmia, or oculofacial-skeletal myorhythmia are pathognomic.

• Patients with Whipple’s disease usually appear tired and weak.
• Cachexia

• Low-grade intermittent fever
• Tachycardia
• Hypotension
• Tachypnea

• Pallor
• Hyperpigmentation in sun exposed areas
• Cyanosis
• Skin nodules

• Nystagmus
• Papilledema
• Abnormal eye movements
• Oculomasticatory myorhythmia (pathognomonic)
• Oculofacial-skeletal myorhythmia (pathognomonic)

• Lymphadenopathy (common in peripheral lymph nodes)

• In patients who develop pleural effusion, may have:
  • Asymmetrical chest expansion
  • Lungs are hyperresonant
  • Distant breath sounds
  • Reduced tactile fremitus

• Systolic murmur
• Pericardial friction rub
• Pericardial knock
• Wide split of S2
• Elevation of jugular venous pulse

• Abdominal distention
• Hepatosplenomegaly
• Jaundice
• Edema
• Ascites

• May be asymptomatic
• Altered level of consciousness
• Seizure
• Myoclonus
• Ataxia
• Supranuclear ophthalmoplegia
• Dementia
• Hemiparesis

• Arthritis
• Joint deformity (extremely rare)

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