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Symptoms of Whipples disease
There are four commonly recognized manifestations of T. whipplei infections: 1) classic Whipple’s disease, 2) localized chronic infections (usually endocarditis), 3) acute infections (i.e., pneumonia, gastroenteritis), and 4) bacterial carriage. Classic Whipple’s disease is often divided into early (<6 years), middle (6–8 years), and late (>8 years) phases. Hyperpigmentation of the skin is found in 50% of patients and may be related to vitamin malabsorption.
Common Disease Course for Classic Whipples Disease
| Early Phase (<6 years) | Middle Phase (6–8 years) | Late Phase (>8 years) |
|---|---|---|
| Intermittent arthralgias or arthritis (60%–80%) | Diarrhea (80%) | CNS symptoms (6%–63%) |
| Fevers (19%–54%) | Weight loss (93%) | Cardiovascular |
| Abdominal pain (23%–60%) | ||
| Lymphadenopathy (35%–66%) | ||
| Skin hyperpigmentation (50%) | ||
| Anemia (80%) | ||
| Less common manifestations | ||
| Cutaneous lesions | Pancytopenia | Ocular (4%–27%) |
| Subcutaneous lesions |
The multisystem manifestations of Whipple’s disease can be remembered using the following mnemonic:
| W asting/weight loss | D iarrhea |
| H yperpigmentation of skin | I nterstitial nephritis |
| I ntestinal pain | S kin lesions |
| P ancytopenia | E ye inflammation |
| P sychiatric symptoms | A rthritis |
| L ymphadenopathy | S upranuclear ophthalmoplegia |
| E ncephalopathy | E ndocarditis |
| S teatorrhea |
