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Whipple's disease: symptoms
Last reviewed: 20.11.2021
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The symptoms of Whipple's disease are as follows:
In 2/3 of the patients at the onset of the disease, the leading signs are pain in small and large joints of a migratory nature; there are usually no objective signs of inflammation of the joints. Arthritis, intermittent, migratory, affects large and small joints. Unlike rheumatoid arthritis, persistent deformity is rare. However, as a rule, only arthralgias occur without physical or radiological changes in the joints. There is often a fever. In many patients, recurrent tracheobronchitis occurs.
These manifestations of the initial phase of the disease can precede the development of the main clinical symptoms of the disease in 3-8 years.
Gastrointestinal manifestations are characteristic for the advanced stage of the disease:
- Chronic diarrhea - stool abundant, 5-10 times a day, with the allocation of a large amount of fat. Occasionally, melena is possible. The presence of a blood impurity is usually associated with a violation of coagulation due to hypoprothrombinemia caused by a defective absorption of vitamin K. Diarrhea is a common but not an obligatory symptom. Individual patients, especially at the onset of the disease, suffer from constipation;
- Flatulence. Often there is bloating.
- Pain in mesogastric can be of different intensity, at times in the form of a sensation of bursting after eating, at times in the form of colic, relieved after the departure of stool and gases. Sometimes the pain and flatulence are very pronounced, so patients with suspicion of ileus are hospitalized in the surgical department;
- pain of varying intensity in the near-umbilical region, diminishing after gas refreshing and defecation;
- tenderness in the palpation of the peri-oophoric region, in many patients it is possible to palliate the enlarged mesenteric, as well as peripheral lymph nodes - they are painless, not soldered to the skin, sufficiently mobile;
- decreased appetite;
- Progressive weight loss, muscle atrophy, increasing muscle weakness; gradually manifestations of protein deficiency, violations of fat, 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 in the pathological process of other organs and systems:
- symptoms of adrenal insufficiency: low blood pressure, skin pigmentation (especially open areas of the body, face, neck, hands); anorexia, often nausea, vomiting; propensity to hypoglycemia; hyponatrism;
- signs of central nervous system damage: hearing impairment, visual disturbances, ataxia, damage to the cranial nerves (ophthalmoplegia, nystagmus, facial nerve paresis), as well as peripheral nervous system in the form of polyneuropathy;
- development of fibrous endocarditis, myocarditis, pericarditis, polyserositis, coronaritis;
- skin changes (erythema), erythema nodosum.