Vom Schlaganfall über Gelenkschwellungen zum M. Whipple – Fallvorstellung aus der neurologischen Rehabilitation mit Literaturrecherche

Zusammenfassung

Der M. Whipple ist eine seltene Systemerkrankung verursacht durch eine chronische Infektion mit Tropheryma Whipplei, deren Diagnose häufig erst Jahre nach Auftreten erster Symptome gestellt werden kann. Die Symptome sind vielfältig und zuweilen unspezifisch. Neben Kachexie, rezidivierenden Gelenkschwellungen und abdominellen Beschwerden kommen auch neurologische Symptome wie Demenz, Myoklonus oder Pyramidenbahnaffektionen vor. Im vorgestellten Fall traten Symptome wie Gelenkschwellungen und Spasmen der Beine während der neurologischen Rehabilitation nach einem paramedianen Ponsinfarkt auf. Durch die enge Zusammenarbeit der neurologischen Rehabilitationsmediziner mit rheumatologischen Kollegen konnte die Diagnose eines M. Whipple gestellt werden. Nach Einleiten der leitliniengerechten Therapie mit Ceftriaxon gefolgt von Sulfamethoxazol-Trimethoprim besserten sich die Gelenkergüsse und auch überraschenderweise die Spasmen der Beine innerhalb weniger Tage.

Abstract

Whipple’s disease is a rare systemic disease caused by a chronic infection with Tropheryma whipplei, which can often only be diagnosed years after the first symptoms appear. The symptoms are varied and sometimes unspecific. In addition to cachexia, recurrent joint swelling and abdominal complaints, neurological symptoms with dementia, myoclonus and motor neuron disease also occur. In the reported case, symptoms such as joint swelling and spasms of the legs occurred during neurological rehabilitation following a paramedian pons infarction. The close collaboration between the neurological rehabilitation physicians and rheumatology colleagues made it possible to diagnose Whipple’s disease. Guideline-compliant treatment with ceftriaxone followed by sulfamethoxazole-trimethoprim was initiated. This improved the joint effusions and, surprisingly, also the spasms of the legs within a few days.

Schlüsselwörter

M. Whipple - Arthritis - neurologische Symptome

Keywords

M. Whipple - Arthritis - Neurological symptoms

Publication History

Received: 27 October 2024

Accepted after revision: 14 July 2025

Article published online:
26 August 2025

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