Central nervous system Whipple's disease: relapse during therapy with trimethoprim-sulfamethoxazole and remission with cefixime. Gastroenterology 1994 Mar;106(3):782-6
Date
03/01/1994Pubmed ID
7509765DOI
10.1016/0016-5085(94)90716-1Scopus ID
2-s2.0-0028055017 (requires institutional sign-in at Scopus site) 75 CitationsAbstract
The central nervous system (CNS) is frequently involved in patients with Whipple's disease and is the most common site of disease relapse. Antibiotics such as trimethoprim-sulfamethoxazole (TMP-SMX) that have reliable CNS penetration, are therefore recommended as first-line therapy. We report a patient with Whipple's disease who was treated with TMP-SMX and presented 14 months after initiation of therapy with visual decline and severe headaches. The patient was also treated concurrently with low-dose weekly methotrexate for severe psoriasis. Evaluation by magnetic resonance imaging revealed bilateral posterior white matter abnormalities that pathologically were consistent with Whipple's disease. He was ultimately treated with cefixime, an orally administered third-generation cephalosporin. Visual function improved on this regimen and follow-up magnetic resonance imaging showed regression of the lesions. This case represents the first report of both CNS relapse during therapy with TMP-SMX and successful treatment with cefixime. We also speculate that methotrexate, which impairs cell-mediated immunity, may have contributed to the relapse.
Author List
Cooper GS, Blades EW, Remler BF, Salata RA, Bennert KW, Jacobs GHAuthor
Bernd F. Remler MD Professor in the Neurology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
CefiximeCefotaxime
Central Nervous System Diseases
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Recurrence
Remission Induction
Trimethoprim, Sulfamethoxazole Drug Combination
Vision Disorders
Whipple Disease
