Severe Hypothermia in a Patient with Cerebral Relapse of Whipple?s Disease

Neurologic manifestations of Whipple’s disease

Whipple's disease is a rare, multisystem, infectious disorder caused by the bacterium Tropheryma whippelii. Patients with central nervous system (CNS) involvement may present in a variety of ways, including cognitive impairment, psychiatric manifestations, gaze palsies, upper motor neuron signs, and hypothalamic dysfunction. A tissue-based diagnosis of Whipple's disease is made based on the presence of periodic acid-Schiff-stained material or by the identification of bacterial RNA using polymerase chain reaction. To avoid relapse, patients should be treated with antimicrobial agents that penetrate the CNS, and therapy should be continued for at least 1 year.

Hypothermies spontanées : dix observations, place du syndrome de Shapiro

SUBJECT

Hypothermia (defined as a core temperature lower than 35 degrees C) may result from accidental causes (exposure to cold, drug intoxications), from endocrine disorders (hypothyroidism), or from central or peripheral neurological disease. Among the causes of spontaneous hypothermia, the place of spontaneous periodic hypothermia or Shapiro's syndrome, of which less than 50 cases in children or adults have been reported, remains unclear.

METHODS

Case series of spontaneous hypothermia in adults, from a register of the French Society of Internal Medicine (SNFMI).

RESULTS

The ten collected cases of spontaneous hypothermia are heterogeneous. In half of the cases, an often ill-labeled psychiatric illness and/or epilepsy and/or anti-psychotic medication were found contributive. Only 5 cases at best seem to conform to the pattern of spontaneous periodic hypothermia or Shapiro's syndrome (in which agenesis of corpus callosum is typically found). In such cases, the episodes of hypothermia start with profuse hyperhidrosis suggesting a paroxystic reset of the hypothalamic thermostat with a lower temperature set point. In none of the cases was found a significant encephalic lesion. None of the treatment trials with anti-epileptics or cyproheptadine were found useful. Spontaneous hypothermia, whether periodic or not, seems to have an unpredictable course, with long periods of remission, and a benign long-term outcome.

CONCLUSIONS

Spontaneous hypothermia is a symptom of likely multifactorial etiology. Even in cases conforming to the definition of Shapiro's syndrome, central nervous system anomalies are not unequivocal. No specific treatment for spontaneous hypothermia, whether periodic or not, can be recommended in the current state of knowledge.