Résumé
A doença de Whipple (DW) é distúrbio multissistêmico raro causado pelo bacilo Tropheryma whipplei. O envolvimento do sistema nervoso central é um aspecto clássico da doença, sendo observado em 20 a 40% dos pacientes. Relatamos o caso de homem de 62 anos com DW que desenvolveu manifestações neurológicas durante sua evolução, com o objetivo de discutir os sinais e sintomas mais comuns e destacar os critérios diagnósticos e propostas terapêuticas mais recentes.
Sujets)
Humains , Mâle , Adulte d'âge moyen , Encéphalopathies/étiologie , Maladie de Whipple/complications , Biopsie , Encéphalopathies/diagnostic , Diarrhée/étiologie , Imagerie par résonance magnétique , Polyneuropathies/diagnostic , Polyneuropathies/microbiologie , Tomodensitométrie , Association triméthoprime-sulfaméthoxazole/usage thérapeutique , Maladie de Whipple/diagnostic , Maladie de Whipple/traitement médicamenteuxRésumé
Hypertrophic pachymeningits is an unusual cause of neurological symptoms and is often secondary to infections, carcinomatosis or inflammatory diseases. It may also be idiopathic. We report a case of pachymeningitis which was manifested primarily by psychosis and visual loss with optic atrophy and destruction of nasal septum. The patient, a 45 year old woman was submitted to extensive investigation without evidence of any underlying disease. A meningeal biopsy was performed and showed a mostly unspecific inflammatory process with extensive fibrosis of the dura and few early stage granulomas. These findings suggest either neurosarcoidosis or idiopathic hypertrophic pachymeningitis