Whipple's disease - Symptoms.

Symptoms of Whipple's disease include:

In 2/3 of patients, the leading symptoms at the onset of the disease are pain in small and large joints of a migratory nature; there are usually no objective signs of joint inflammation. Arthritis, intermittent, migratory, affects large and small joints. Unlike rheumatoid arthritis, persistent deformation is rare. However, as a rule, only arthralgia occurs without physical or radiologically determined changes in the joints. Fever is often observed. Many patients experience recurrent tracheobronchitis.

The indicated manifestations of the initial phase of the disease may precede the development of the main clinical symptoms of the disease by 3-8 years.

Gastrointestinal manifestations are characteristic of the advanced stage of the disease:

• Chronic diarrhea - profuse stool, 5-10 times a day, with the release of a large amount of fat. Melena is occasionally possible. The presence of blood is usually associated with a coagulation disorder due to hypoprothrombinemia caused by a defect in the absorption of vitamin K. Diarrhea is a common, but not obligatory symptom. Some patients, especially at the beginning of the disease, suffer from constipation;
• Flatulence. Abdominal bloating is often observed.
• Mesogastric pain can be of varying intensity, sometimes in the form of a feeling of distension after eating, sometimes in the form of colic, relieved after the passage of stool and gases. Sometimes the pain and flatulence are very pronounced, so patients with suspected ileus are hospitalized in the surgical department;
• pain of varying intensity in the umbilical region, decreasing after the passage of gases and defecation;
• pain on palpation of the umbilical region; in many patients, it is possible to palpate enlarged mesenteric and peripheral lymph nodes - they are painless, not fused with the skin, and are quite mobile;
• decreased appetite;
• progressive weight loss, muscle atrophy, increasing muscle weakness; gradually developing manifestations of protein deficiency, disorders of fat and carbohydrate metabolism, milk intolerance, polyhypovitaminosis, hypocalcemia, hypoproteinemic edema.

Extragastrointestinal manifestations. Whipple's disease is a systemic disease. It is characterized by the following signs of involvement of other organs and systems in the pathological process:

• Symptoms of adrenal insufficiency: low blood pressure, skin pigmentation (especially exposed areas of the body, face, neck, hands); anorexia, often nausea, vomiting; tendency to hypoglycemia; hyponatrismia;
• signs of damage to the central nervous system: hearing impairment, visual disturbances, ataxia, damage to the cranial nerves (ophthalmoplegia, nystagmus, facial nerve paresis), as well as the peripheral nervous system in the form of polyneuropathy;
• development of fibrous endocarditis, myocarditis, pericarditis, polyserositis, coronaritis;
• skin changes (erythema), erythema nodosum.