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January 1969

Whipple's Disease and Papilledema: An Unreported Presentation

Author Affiliations


From the Cleveland Veterans Administration Hospital, and the departments of medicine (Dr. Switz), neurology (Dr. Casey), and pathology (Dr. Bogaty), Case-Western Reserve University School of Medicine, Cleveland. Dr. Switz is now; with the Gastrointestinal Research Unit, Mayo Clinic, Rochester, Minn; Dr. Casey is now with the General Electric Corp., Syracuse, NY; and Dr. Bogaty is now with the Physicians Medical Laboratories, Portland, Ore.

Arch Intern Med. 1969;123(1):74-77. doi:10.1001/archinte.1969.00300110076015

In 1907, Whipple1 described the idiopathic systemic disease with prominent small bowel abnormalities that bears his name. Later studies have emphasized multiple organ involvement 2 and suggested the presence of an infectious particle.3,4 Review of the literature suggests that central nervous system (CNS) involvement by Whipple's disease is infrequent but not rare.

This report describes a patient with unusual manifestations of Whipple's disease consisting of visual disturbances, prolonged papilledema, and elevated cerebrospinal fluid (CSF) pressure and protein. Clinical symptoms of small bowel involvement were absent.

Patient Summary  A 49-year-old white auto worker entered another hospital in March 1965. He had experienced momentary vertigo in December 1964, and "blurred vision" followed. He recalled having arthralgias involving knees, ankles, and hands for six years; no amelioration was obtained with methylprednisolone, 12 mg daily, from February 1964 to December 1964. Past history, family history, and review of systems were noncontributory.Physical