Coma chronique compliquant une maladie de Whipple avec biopsies du grêle et biopsie cérébrale négatives

A 57 year-old man was admitted to the hospital because of diarrhea and fever, followed by progressive mental disturbances and coma. Several jejunal and one cerebral biopsies as well as CSF studies failed to disclose any PAS-positive macrophages (PPM). Despite antibiotherapy, death occurred 13 months later. Neuropathological study demonstrated, throughout the CNS, multiple small foci of very dense gemistocytic gliosis with collections of scattered or perivascular PPM. The bacilli known in Whipple's disease were seen on electron photomicrographs.