Whipples_Disease_guest_lecture

The patient is a 44 year old woman with a past history of ethanol abuse. She was transferred to the Massachusetts General Hospital (MGH) on 3/10/93 for evaluation of memory impairment, hypothalamic dysfunction and a one month history of diplopia and ataxia. In February 1992 (13 months PTA), she developed a rapid decline in short term memory, having problems recalling where she placed objects, what she had just eaten, or what she had just read. In June 1992 (9 months PTA), she experienced an episode of excruciating abdominal pain and hematuria. Investigation at an outside hospital included a negative IVP and CT of the abdomen. In September 1992, (6 months PTA), she was admitted to St. Mary's Hospital, Maine with increased confusion and decreased memory which prevented her working as a computer data entry clerk. Investigations included a normal brain MRI without Gadolinium, Cerebrospinal fluid (CSF): normal glucose, mildly elevated protein at 78 and l0 lymphocytes. An ESR 57 in 1 hr. An RPR test was reported positive, but a subsequent MHA-TP was negative. She had a serum Na of 123 and the syndrome of inappropriate ADH secretion (SIADH) was diagnosed and treated with fluid restriction. An EEG, thyroid function studies, liver function tests, chest CT, bronchoscopy, vitamin B12 levels, Lyme titers, and small bowel biopsy were within normal limits. An ANA was positive at 1:16, but the rheumatoid factor was