Turkish Neurosurgery 2018 , Vol 28 , Num 3
Whipple Disease Presenting as Cystic Brain Tumor: Case Report and Review of the Literature
Mohamed KILANI1,Leila NJIM2,Atef Ben NSIR1,Mohamed Nejib HATTAB1
1Fattouma Bourguiba University Hospital, Department of Neurosurgery, Monastir, Tunisia
2Fattouma Bourguiba University Hospital, Department of Pathology, Monastir, Tunisia
DOI : 10.5137/1019-5149.JTN.17111-16.2 Although neurological features are commonly encountered in Whipple"s disease (WD), presentation with purely neurological patterns is uncommon. Exclusive confinement to the central nervous system (CNS) is extremely rare. In these cases, the development of an isolated cerebral mass is exceptional.

In the present paper, the authors describe a case of a 68-year-old man who presented with partial seizures. The neurological examination was normal. The imaging showed a cystic lesion. This tumor-like lesion was removed by performing frontal craniotomy. A histopathological investigation revealed the presence of numerous perivascular foamy histiocytes infiltrating the brain parenchyma. The majority of these histiocytes showed Periodic acid?schiff (PAS)-positive intense staining, which is distinctive feature of cerebral WD. The diagnosis was confirmed by polymerase chain reaction (PCR) analysis of cerebrospinal fluid. There were no gastrointestinal symptoms and no PAS inclusions in intestinal mucosa. The patient received Ceftriaxone intravenously followed by oral trimethoprime-sulfamethoxazole (TMP-SMZ) for 12 months and recovered well. This case illustrates atypical WD, confined exclusively to the central nervous system. Keywords : Whipple disease, Tropheryma whippelii, Encephalitis, Central nervous system

Corresponding author : Mohamed KILANI, kilanineurochirurgien@gmail.com