An interesting case study reported in Lancet Rheumatology , describes a 58-year-old woman with a seven-year history of chronic intermittent arthritis, weight loss, sleep disturbance, anxiety, ocular motor abnormalities and progressive cognitive impairment. She was hospitalised for impaired consciousness and respiratory failure. Examination revealed oculomasticatory myorhythmia (OMM), which, along with positive periodic-acid-Schiff (PAS) staining on jejunal biopsy samples and the detection of Tropheryma whipplei in cerebrospinal fluid, led to a diagnosis of Whipple’s disease.
After receiving antibiotic therapy for pneumonia, she was treated with a combination of sulfadiazine, doxycycline and hydroxychloroquine. Cognitive impairment and myorhythmia did not improve with the treatment.
Whipple’s disease is a systemic infectious disease caused by Tropheryma whipplei. It is characteristic in the middle-age men and begins with recurrent arthritis, followed years later by digestive and neurological problems. Chronic seronegative polyarthritis and joint damage have also been associated with Whipple’s disease.
The infection can mimic almost any neurological and neuropsychiatric disease. The triad of progressive dementia, supranuclear gaze palsies and myoclonus is suggestive of Whipple’s disease. OMM is defined as synchronous vergence eye movement synchronous with masticatory myorhythmia (uncontrolled contractions of masticatory muscles). This uncommon symptom is pathognomonic of Whipple’s disease and indicates the need for a prolonged and specific antibiotic treatment.