PMC10348829_01
Clinical impressions. (A) MCP joint II/III swelling of the left hand. (B) Ankle swelling of the right leg. (C) T1-weighted MRI images of the right hand, showing erosions in coronary and axial planes. (D) Overlay of audiometry curves for the right and left ear, before and after 6 months of antibiotic administration
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In the following months, the patient had continuing polyarthritis (Fig. 1A, B), mostly affecting the MCP, wrist and ankle joints. Radiography revealed initial erosions in the finger and toe joints (Fig. 1C). Furthermore, he reported the onset of dizziness, nausea, headache, tinnitus and an increasing symmetrical hearing loss, which was objectified with audiometry (Fig. 1D), but otolaryngological evaluation revealed no probable causes. Polyarthritis, dizziness, nausea, headaches, tinnitus and hearing loss steadily receded and were almost completely resolved after 6 months (Fig. 1D). Although neurological symptoms caused by Whipple's disease are often irreversible, fortunately almost complete recovery could be achieved with antibiotic treatment (Fig. 1D).