Adalimumab, etanercept and golimumab

Abstract

Adalimumab, etanercept and golimumabAggravation of Whipple's disease: case report A 52-year-old woman experienced aggravation of Whipple's disease during treatment with etanercept, adalimumab and golimumab for a seronegative spondyloarthritis misdiagnosis [routes and dosages not stated].The woman was initially diagnosed with human leucocyte antigen B 27 (HLA B27)-negative spondyloarthritis for four years with left sacroiliitis. She received treatment with unspecified non-steroidal anti-inflammatory drug and methotrexate, which was inefficient. Therefore, she received treatments with anti-tumour necrosis factoretanercept, adalimumab and golimumab for fourteen months on rotational basis. However, these treatments were also inefficient. Suddenly, her general state deteriorated and she experienced biological inflammation, which led to etanercept, adalimumab and golimumab discontinuation. She developed paraesthesia of one arm and transient diplopia. Six moths later, CT-PET scan revealed diffuse active mesenteric polyadenopathies. Trophyrema whipplei polymerase chain reactions on saliva, blood and stools were highly positive. Additionally, duodenitis and lymph node biopsies showed a macrophagic periodicacid-Shiff positive infiltrate, which confirmed Whipple's disease. The initial diagnosis of seronegative spondyloarthritis was considered to be a misdiagnosis.The woman received treatment with doxycycline and hydroxychloroquine. Eventually, her inflammatory parameters normalised, and a significant improvement in her Whipple's disease was noted.Author comment: "Whipple's disease (WD) mimicking a chronic inflammatory rheumatism with a severe weight loss and diarrhea is often undiagnosed." "Finally, lack of a response or paradoxical aggravation of [spondyloarthritis], or seronegative polyarthritides, during biologics should evoke [Whipple's disease]. Causality (C2S2) has been assessed by using the French method."