every meal brought a stabbing pain in her gut

a 57-year-old woman with a history of rheumatoid arthritis presented with stabbing abdominal pain, weight loss, weakness, anemia, and hypokalemia, and was worsening despite a gluten-free diet. every meal brought a stabbing pain in her gut. if this was celiac, why didn’t it stop when she cut out the gluten, she wondered.

yesterday, i read with interest this case of “fake celiac disease” written by lisa sanders m.d. in the new york times magazine.

my assumption initially was the patient had a chronic infection, perhaps disseminated tuberculosis, because she had a history of rheumatoid arthritis and was possibly on a TNF-alpha inhibitor.

i was also thinking about other infections such as fungal diseases.

however, the pathology of her endoscopy showed “something inside the macrophages,” and she was eventually diagnosed with whipple’s disease.

whipple’s disease is a rare infection caused by a bacteria called tropheryma whipplei.

t. whipplei. causes culture negative endocarditis, malabsorption and chronic diarrhea, and other manifestations include fever, lymphadenopathy, edema, arthritis, central nervous system changes, gray-brown skin pigmentation, aortic insufficiency and mitral stenosis, and oculomasticatory myorhythmia (eye oscillations and mastication muscle contractions). i suspect there are more cases of whipple’s disease than most people recognize because it is hard to diagnose.

in other news, i’m up to 28 miles in my quest for 500 to end suicide and fear, and r-e-s-p-e-c-t myself once again, and hope i’ll see you along the way. today i’ll be biking, running, and walking around boston.

if you found this post useful, please leave a reply below.

best regards,

philip albert lederer m.d.

ps– oculomasticatory myorhythmia below, and some beautiful violin music

Screen Shot 2018-08-20 at 4.17.35 AM

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