Whipple's disease physical examination

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

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 by the disease.

Physical Examination

• Physical examination of patients with Whipple's disease is usually remarkable for generalised weakness secondary to weight loss and joint pain in peripheral joints.
• The presence of eye findings namely Oculomasticatory, or oculofacialskeletal, myorhythmia are pathognomic.

Appearance of the Patient

• Weak and tired some times severe enough to cause cachexia secondary to malabsorption and weight loss.

Vital Signs

• Low-grade intermittent fever
• might be associated with night sweats

Skin

• Hyperpigmentation : more frequent in sun exposed areas.
• Some patients may develop skin nodules

• Description (Adapted from Dermatology Atlas)

  Description (Adapted from Dermatology Atlas)

• 

  Description (Adapted from Dermatology Atlas)

HEENT

• Nystagmus
• Extra-ocular movements abnormal.
• Oculomasticatory, or oculofacialskeletal, myorhythmia are pathognomic.

Neck

• Lymphadenopathy is common.
• Peripheral lymph nodes may be palpable.

Lungs

In patients who develop pleural effusion

• lungs are hyporesonant
• asymmetrical chest expansion.
• Distant breath sounds
• Reduced tactile fremitus

Heart

• systolic murmur with cardiac valve involvement.

Abdomen

• Abdominal bloating and cramps .
• hepatosplenomegaly

Neuromuscular

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

Extremities

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