trimethoprim--sulfamethoxazole-drug-combination and Dementia

A 69-year old patient who had been treated for joint pain over a long time was admitted because of weight loss and dementia. He was confused and cachectic with edema and skin hyperpigmentation.. Laboratory findings indicated chronic infection. Duodenal biopsy revealed Whipple's disease. The PCR of cerebrospinal fluid for Tropheryma whipplei was negative.. During treatment with ceftriaxon and intravenous fluid therapy the patient's mental state improved. However his motoric state remained insufficient.. Whipple's disease should be considered in dementia, even more in previous "rheumatic symptoms", in order to avoid ineffective (immunosuppressive) treatment with unfortunate consequences.

Topics: Aged; Anti-Bacterial Agents; Biopsy; Ceftriaxone; Colonoscopy; Combined Modality Therapy; Dementia; Diagnosis, Differential; Duodenum; Endoscopy, Digestive System; Fluid Therapy; Humans; Intestinal Mucosa; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography; Whipple Disease

Topics: Amygdala; Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Dementia; Diagnosis, Differential; Female; Humans; Kluver-Bucy Syndrome; Magnetic Resonance Imaging; Middle Aged; Paresis; Temporal Lobe; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

We describe a case of reversible dementia caused by Tropheryma whippelii (TW). Diagnosis was confirmed by a positive polymerase chain reaction for this pathogen both on serum and cerebrospinal fluid. Specific antibiotic therapy resulted in distinct clinical and neuroradiological improvement. Control polymerase chain reaction for T. whippelii on serum and cerebrospinal fluid was negative.

Topics: Aged; Anti-Bacterial Agents; Central Nervous System Infections; Dementia; Drug Therapy, Combination; Female; Humans; Remission Induction; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease