CENTRAL-NERVOUS-SYSTEM WHIPPLES-DISEASE - RELAPSE DURING THERAPY WITH TRIMETHOPRIM-SULFAMETHOXAZOLE AND REMISSION WITH CEFIXIME

被引:59
作者
COOPER, GS [1 ]
BLADES, EW [1 ]
REMLER, BF [1 ]
SALATA, RA [1 ]
BENNERT, KW [1 ]
JACOBS, GH [1 ]
机构
[1] UNIV HOSP CLEVELAND,CASE WESTERN RESERVE,SCH MED,DEPT NEUROL OPHTHALMOL & PATHOL,CLEVELAND,OH
关键词
D O I
10.1016/0016-5085(94)90716-1
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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 cellmediated immunity, may have contributed to the relapse. © 1994.
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收藏
页码:782 / 786
页数:5
相关论文
共 26 条
  • [21] OCULOMASTICATORY MYORHYTHMIA - A UNIQUE MOVEMENT DISORDER OCCURRING IN WHIPPLES DISEASE
    SCHWARTZ, MA
    SELHORST, JB
    OCHS, AL
    BECK, RW
    CAMPBELL, WW
    HARRIS, JK
    WATERS, B
    VELASCO, ME
    [J]. ANNALS OF NEUROLOGY, 1986, 20 (06) : 677 - 683
  • [22] SHIROKY JB, 1991, J RHEUMATOL, V18, P1172
  • [23] CENTRAL NERVOUS SYSTEM INVOLVEMENT IN WHIPPLES DISEASE
    SIERACKI, JC
    FINE, G
    HORN, RC
    BEBIN, J
    [J]. JOURNAL OF NEUROPATHOLOGY AND EXPERIMENTAL NEUROLOGY, 1960, 19 (01) : 70 - 75
  • [24] WALLNER A, 1991, THORAX, V46, P205
  • [25] DISSEMINATED HISTOPLASMOSIS IN PATIENTS RECEIVING LOW-DOSE METHOTREXATE THERAPY FOR PSORIASIS
    WITTY, LA
    STEINER, F
    CURFMAN, M
    WEBB, D
    WHEAT, LJ
    [J]. ARCHIVES OF DERMATOLOGY, 1992, 128 (01) : 91 - 93
  • [26] WHIPPLES DISEASE CONFINED TO THE CNS PRESENTING WITH MULTIPLE INTRACEREBRAL MASS LESIONS
    WROE, SJ
    PIRES, M
    HARDING, B
    YOUL, BD
    SHORVON, S
    [J]. JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 1991, 54 (11) : 989 - 992