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A 42-year-old male presents with memory loss over the last several months. He notes antecedent arthralgia, low-grade fevers, skin hyperpigmentation, and frequent diarrhea. On examination he has mild rigidity in his upper extremities, and concurrent slow pendular movements of the eyes and contraction of the masseter. Which of the following is the most likely diagnosis?
Explanation
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Whipple disease is caused by an infection with Tropheryma whippelii, leading to low-grade fevers, arthralgia, diarrhea, muscle wasting, and hyperpigmentation. Neurological symptoms include extrapyramidal symptoms, limitations of vertical gaze, and characteristic oculomasticatory myorhythmia (pendular oscillations of the eyes with rhythmic contractions of the masticatory muscles)<br><br>Wilson disease is an autosomal-recessive disorder resulting in accumulation of copper resulting in liver causing movement disorders and dementia.<br><br>Neurosyphilis causes psychosis agitation, aggression, dementia, multiple cranial neuropathies, and multifocal vasculitic infarcts.<br><br>Early-onset Alzheimer disease presents with dementia but without systemic symptoms or movement disorders
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Reference
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Bradleys NiCP, 7th edn, Ch. 58
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Option 1
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Is Correct (Option 1):
Wilson disease
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Option 2
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Is Correct (Option 2):
Neurosyphilis
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Option 3
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Is Correct (Option 3):
Whipple disease
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Option 4
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Is Correct (Option 4):
Early-onset Alzheimer disease
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