7. One Hundred Years Later

  1. James C. Pile2,
  2. Thomas E. Baudendistel3 and
  3. Brian J. Harte4
  1. Thomas E. Baudendistel3,
  2. Nima Afshar1 and
  3. Lawrence M. Tierney1

Published Online: 21 MAR 2013

DOI: 10.1002/9781118483206.ch7

Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine

Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine

How to Cite

Baudendistel, T. E., Afshar, N. and Tierney, L. M. (2013) One Hundred Years Later, in Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine (eds J. C. Pile, T. E. Baudendistel and B. J. Harte), John Wiley & Sons, Inc., Hoboken, NJ, USA. doi: 10.1002/9781118483206.ch7

Editor Information

  1. 2

    Departments of Hospital Medicine and Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA

  2. 3

    Department of Medicine, Kaiser Permanente Medical Center, Oakland, California, USA

  3. 4

    South Pointe Hospital, Cleveland Clinic Health System, Warrensville Heights, Ohio, USA

Author Information

  1. 1

    Department of Medicine, University of California, San Francisco, California, USA

  2. 3

    Department of Medicine, Kaiser Permanente Medical Center, Oakland, California, USA

Publication History

  1. Published Online: 21 MAR 2013
  2. Published Print: 15 MAR 2013

Book Series:

  1. Hospital Medicine: Current Concepts

Book Series Editors:

  1. Scott A. Flanders and
  2. Sanjay Saint

ISBN Information

Print ISBN: 9780470905654

Online ISBN: 9781118483206

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Keywords:

  • actinobacteria;
  • arthralgias;
  • Whipple's disease

Summary

The case study discussed in this chapter is the index case of Whipple's disease, which is summarized from the original 1907 description. Although Whipple had surmised a novel infectious agent in 1907, it took almost a century to isolate the causative microbe. Phylogenetically classified with the actinobacteria, Tropheryma whipplei was ultimately subcultured in 2000, and immunodetection testing became possible. Whipple's index case report described most of the manifestations of the disease we are familiar with today. As in the original description, arthralgias are the most common initial symptom and may precede diagnosis by a mean of 8 years. Other cardinal features include weight loss, abdominal pain, and steatorrhea due to small intestinal involvement. This chapter summarizes the important signs and symptoms of Whipple's disease. One notable manifestation missing in Whipple's report is central nervous system (CNS) involvement. Historical case reports reinforce the case-based learning paradigm.