Interplay of multiple neurological conditions - the first case of neurological Whipple's disease in Syria: a case report.

Introduction and importance: Whipple disease is a rare systemic infection caused by the bacterium Tropheryma whippelii, commonly affecting the gastrointestinal system, but it can also involve the central nervous system (CNS). Diagnosis typically relies on tissue biopsy and polymerase chain reaction (PCR) for bacterial DNA. This case emphasizes the challenges in diagnosing and treating neurologic manifestations of Whipple disease and highlights the importance of a multidisciplinary approach in managing complex neuroinfectious cases. Case presentation: We report a case of a 35-year-old Syrian female with neurological Whipple disease presenting with recurrent tonic-clonic seizures, cognitive disturbances, and communicating hydrocephalus, requiring a ventriculoperitoneal shunt. Her complex clinical course included pyomeningitis associated with shunt infection. Diagnostic imaging and cerebrospinal fluid (CSF) analyses confirmed CNS involvement. Management included antibiotic therapy targeting CNS infection and antiepileptics. Clinical discussion: There were multiple differential diagnoses for this patient, as well as the interplay of multiple conditions as a result of Whipple disease or medical intervention, which shows the importance of keeping every possibility in mind. Moreover, giving proper instructions to the patient can help reduce complications. Conclusion: The successful treatment and ongoing follow-up demonstrate the importance of a multidisciplinary approach in addressing the diverse manifestations of neurological conditions.