Whipple's disease physical examination: Difference between revisions

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===Appearance of the Patient===
===Appearance of the Patient===
*Weak and tired some times severe enough to cause cachexia secondary to malabsorption and weight loss.
* Patients with Whipple's disease usually appear tired and weak.


===Vital Signs===
===Vital Signs===
 
*Low-grade intermittent [[fever]]
*Low-grade intermittent fever  
*might be associated with night sweats <ref name="pmid11432814">{{cite journal| author=Dutly F, Altwegg M| title=Whipple's disease and "Tropheryma whippelii". | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 3 | pages= 561-83 | pmid=11432814 | doi=10.1128/CMR.14.3.561-583.2001 | pmc=88990 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11432814  }} </ref>


===Skin===
===Skin===
*Hyperpigmentation : more frequent in sun exposed areas. <ref name="pmid11432814">{{cite journal| author=Dutly F, Altwegg M| title=Whipple's disease and "Tropheryma whippelii". | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 3 | pages= 561-83 | pmid=11432814 | doi=10.1128/CMR.14.3.561-583.2001 | pmc=88990 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11432814  }} </ref>
*[[Pallor]]
*Some patients may develop skin nodules  
*[[Hyperpigmentation]]: more frequent in sun exposed areas.<ref name="pmid11432814">{{cite journal| author=Dutly F, Altwegg M| title=Whipple's disease and "Tropheryma whippelii". | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 3 | pages= 561-83 | pmid=11432814 | doi=10.1128/CMR.14.3.561-583.2001 | pmc=88990 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11432814  }} </ref>
 
*Skin nodules
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
===HEENT===
* [[Nystagmus]]   
* [[Nystagmus]]   
* Extra-ocular movements abnormal.
* Abnormal extra-ocular movements  
* Oculomasticatory, or oculofacialskeletal, myorhythmia are pathognomic. <ref name="pmid11432814">{{cite journal| author=Dutly F, Altwegg M| title=Whipple's disease and "Tropheryma whippelii". | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 3 | pages= 561-83 | pmid=11432814 | doi=10.1128/CMR.14.3.561-583.2001 | pmc=88990 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11432814  }} </ref>
* Oculomasticatory (pathognomic)
* Oculofacialskeletal (pathognomic)
* Myorhythmia (pathognomic)


===Neck===
===Neck===
*[[Lymphadenopathy]] is common.
*[[Lymphadenopathy]] (common in peripheral [[lymph nodes]])
*Peripheral lymph nodes may be palpable. <ref name="pmid11432814">{{cite journal| author=Dutly F, Altwegg M| title=Whipple's disease and "Tropheryma whippelii". | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 3 | pages= 561-83 | pmid=11432814 | doi=10.1128/CMR.14.3.561-583.2001 | pmc=88990 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11432814  }} </ref>


===Lungs===
===Lungs===
In patients who develop pleural effusion  
*In patients who develop [[pleural effusion]], may have:
*lungs are hyporesonant
**Asymmetrical chest expansion
*asymmetrical chest expansion.
**Lungs are hyporesonant
*Distant breath sounds
**Distant breath sounds
*Reduced [[tactile fremitus]]
**Reduced [[tactile fremitus]]


===Heart===
===Heart===
Line 61: Line 54:
===Extremities===
===Extremities===
*Arthralgia of peripheral joints : frequently seen   
*Arthralgia of peripheral joints : frequently seen   
*Joint deformity with Whipple's disease is extremely rare  
*Joint deformity with Whipple's disease is extremely rare


==References==
==References==

Revision as of 20:59, 9 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Bhagyashree Deshmankar M.B.B.S.[2]; Sadaf Sharfaei M.D.[3]

Overview

Patients with Whipple's disease usually appear weak. Physical examination of patients with Whipple's disease is usually remarkable for weight loss and joint pain. Further physical findings depend on the systems involved in the disease.

Physical Examination

  • Physical examination of patients with Whipple's disease is usually remarkable for generalized weakness secondary to weight loss.
  • The presence of eye findings namely oculomasticatory, or oculofacialskeletal, myorhythmia are pathognomic.

Appearance of the Patient

  • Patients with Whipple's disease usually appear tired and weak.

Vital Signs

  • Low-grade intermittent fever

Skin

HEENT

  • Nystagmus
  • Abnormal extra-ocular movements
  • Oculomasticatory (pathognomic)
  • Oculofacialskeletal (pathognomic)
  • Myorhythmia (pathognomic)

Neck

Lungs

Heart

Abdomen

Neuromuscular

  • May be asymptomatic
  • May have cognitive changes [1]
  • Altered level of consciousness [1]
  • Seizure[1]
  • Myoclonus
  • Ataxia [1]

Extremities

  • Arthralgia of peripheral joints : frequently seen
  • Joint deformity with Whipple's disease is extremely rare

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Dutly F, Altwegg M (2001). "Whipple's disease and "Tropheryma whippelii"". Clin Microbiol Rev. 14 (3): 561–83. doi:10.1128/CMR.14.3.561-583.2001. PMC 88990. PMID 11432814.

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