CEREBRAL RECURRENCE OF WHIPPLES-DISEASE A FTER TETRACYCLINE TREATMENT

A 57 year old woman presented with a slowly progressive neurological d isorder consisting of myoclonus, hypersomnia and episodic alterations of consciousness. She had a history of biopsy-proven gastrointestinal Whipple's disease for which she had been treated with tetracycline 6 y ears earlier. A lumbar puncture showed a moderate lymphocytic pleocyto sis and additional laboratory tests revealed intestinal malabsorption. These findings suggested a relapse of Whipple's disease with predomin ant CNS involvement. However, the duodenal biopsy did not show the his tological changes typical of Whipple's disease. The patient was treate d with penicillin and streptomycin followed by trimethoprime and sulfa methoxazole and showed a complete remission of her neurological sympto ms as well as normalised laboratory tests. The diversity of neurologic al symptoms as well as the current state of diagnosis and therapy of W hipple's disease are reviewed.