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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."
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."
Introducción: La enfermedad de Whipple es una enfermedad crónica sistémica con predilección por el aparato digestivo, especialmente el intestino delgado. Fue descrita por vez primera en 1907 por George H. Whipple quien la denominó "lipodistrofia intestinal". Es causada por una bacteria grampositiva perteneciente a la familia de los Actinomycetaceae denominada Tropheryma whipplei. Objetivos: Caracterizar a los pacientes con enfermedad de Whipple. Materiales y métodos: Se realizó una revisión sistemática de la literatura, de los términos MeSH “enfermedad de whipple (whipple Disease) y/o (Tropheryma whipplei), en las bases de datos Pubmed/Medline, Scopus, Scielo y Sciencedirect, Embase, Cochrane Library, BIREME, Proquest y Redalyc; se analizaron 123 artículos. Resultados: Se analizaron 123 artículos publicados que correspondían a reportes y series de casos en los cuales se evidencio mayor prevalencia en varones (70,6%). La manifestación más frecuente fueron los síntomas articulares (61%), seguida de pérdida de peso (47,1%) y diarrea (43,4%). El método diagnóstico más fue la reacción en cadena polimerasa (PCR) (63,2%), seguida por la biopsia (50.7%); y por último examen anatomopatológico con gránulos PAS (47,8%). El manejo más empleado fue la antibioticoterapia con predominio de trimetoprim sulfametoxazol y ceftriaxona. Conclusiones: La enfermedad de Whipple tiene una baja prevalencia, se presenta con mayor frecuencia en personas de raza blanca, afecta principalmente a los adultos mayores, además, tiene predilección por el sexo masculino y se caracteriza por ser una enfermedad crónica sistémica con predilección por el aparato digestivo, especialmente el intestino delgado.
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