Whipple's Disease: A Multisystem Infection

Whipple's disease is usually considered an intestinal disorder characterized by malabsorption and macrophages that stain with periodic acidSchiff (PAS). In fact, this disease is a chronic, multisystem, antibiotic-responsive bacterial infection that may produce severe and complex neurologic manifestations. In this issue of the Journal, Feurle et al. describe two patients with the cerebral complications of Whipple's disease, whose histories highlight the concept that neurologic symptoms and signs may develop when gastrointestinal symptoms are minimal,¹ or may be prominent even after antibiotic therapy has “cleared” the intestinal mucosa of bacterial bodies and PAS-positive macrophages.² Some neurologic dysfunction would be expected.