Whipple’s Disease: A Case Report

Kutlu, Orkide; Erhan, Selma Şengiz; Gökden, Yasemin; Kandemir, Özlem; Tükek, Tufan

doi:10.1159/000498909

Cited by 11 publications

(12 citation statements)

References 10 publications

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“…Classic WD is characterized by diarrhea, weight loss, abdominal pain, and joint pain [2][3][4]7]. Symptoms may take years to develop and to be diagnosed, due to their vague and chronic nature [8].…”

Section: Discussionmentioning

confidence: 99%

“…Classic WD is characterized by diarrhea, weight loss, abdominal pain, and extra-intestinal involvement manifesting as joint pain, endocarditis, dementia, supranuclear gaze palsy, and mediastinal lymphadenopathy. Even though the definitive diagnosis of WD requires a tissue biopsy, immunohistochemistry can also be utilized as secondary confirmatory testing [2][3][4][5][6]. Treatment commonly includes two weeks of ceftriaxone followed by one year of suppressive therapy with trimethoprimsulfamethoxazole, however, alternate antibiotic courses have been proposed to prevent disease relapse [2][3].…”

Section: Introductionmentioning

confidence: 99%

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Whipple's Disease (WD) Without Arthropathy in an Immunocompromised Patient

Khrais¹,

Han²,

Ramasamy³

et al. 2022

Cureus

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Whipple's disease (WD) is a rare disorder caused by the pathogen Tropheryma whipplei (T. whipplei). We report a unique presentation of WD in which the patient did not exhibit arthralgia which is characteristic of this disease. A 67-year-old man with a history of chronic hepatitis B infection and human immunodeficiency virus (HIV) infection presented with weight loss, nausea, vomiting, and myalgia. Endoscopy demonstrated erythema in the gastric body, lymphangiectasia of the duodenum, and increased granularity of the terminal ileum. Mucosal biopsies revealed macrophages in the lamina propria with focal histiocytic aggregates throughout the small bowel and cecum, consistent with WD. Confirmatory T. whipplei polymerase chain reaction (PCR) testing was positive. WD is a rare diagnosis that must be considered in the differential diagnoses of patients presenting with unexplained nausea, vomiting, diarrhea, and anemia. Furthermore, in patients with HIV, the possibilities would also include opportunistic gastrointestinal pathogens. Classic WD is characterized by diarrhea, weight loss, abdominal pain, and extra-intestinal involvement manifesting as joint pain. We describe a case of WD occurring in a patient with HIV, without the disease's characteristic joint involvement.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Whipple's Disease (WD) Without Arthropathy in an Immunocompromised Patient

Khrais¹,

Han²,

Ramasamy³

et al. 2022

Cureus

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“…In both patients with initially normal duodenal findings and solely positive T. whipplei-specific PCR results of extra-duodenal specimens, repeated duodenal biopsies showed WD-like histological changes, and positive T. whipplei-specific PCR results were obtained. In these patients, T. whipplei-specific immunohistochemistry could be an excellent diagnostic test with very high specificity and sensitivity which allows for the identification of T. whipplei in PAS and PCR-negative specimens [19,20]; otherwise, repeated duodenal biopsies with PAS and PCR detection are also required [18,21].…”

Section: Discussionmentioning

confidence: 99%

Cutaneous Granulomatosis Revealing Whipple’s Disease: Value of Tropheryma whipplei Polymerase Chain Reaction Assay for the Diagnosis

et al. 2021

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Whipple’s Disease is a rare systemic infectious disease caused by the ubiquitous actinomycetes Tropheryma whipplei (T. whipplei). We report herein a rare case of a cutaneous granulo matosis with hypercalcemia as an unusual presenting feature of Whipple’s disease. The diagnosis of the bacteria was obtained from skin and inguinal lymph node biopsy (16 rDNA PCR screening and histological examination using PAS staining). T. whipplei was also identified on saliva and stool specimens, using specific PCR and colonic biopsies. Treatment with hydroxychloroquine and doxycycline allowed a rapid resolution of symptoms with a complete recovery.

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“…In some cases, this enteropathy caused by T. whipplei may be severe and lethal. [ 24 25 26 ] Furthermore, a considerable association between WD and the immunomodulatory condition was indicated in the literature. [ 27 ] In the study conducted by Amsler et al ., 4.2% of saliva and stool samples were positive for T. whipplei in GI patients.…”

Section: Discussionmentioning

confidence: 99%

Molecular detection of Tropheryma whipplei, Cryptosporidium spp., and Giardia lamblia among celiac disease samples

Sayyadi

Hosseinzadeh

et al. 2020

J Res Med Sci

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Background: Celiac disease (CD) is one of the most common disorders, resulting from both environmental (gluten) and genetic factors. The clinical features of the Iranian CD are still unknown and there is insufficient information about the atypical presentation of CD from Iran. As, many previous reports revealed an association between controlled protozoal infections and the CD according to cytokines production, the aim of this study was to determine the prevalence of CD and possible co-infection with the most prevalent protozoal infections including Tropheryma whipplei , Cryptosporidium , and Giardia duodenalis among CD samples. Materials and Methods: In this study, from April 2014 to November 2016, 524 samples were obtained from small intestine of patients with gastrointestinal diseases referring to the Pathology Department of Namazi Hospital, Shiraz, Iran. Multiplex polymerase chain reaction assay was then performed on the histological positive CD samples for the prevalence of the microorganisms. Results: Sixty-four (12.21%) patients were diagnosed as having CD by histopathological examination. The prevalence of T. whipplei and Cryptosporidium spp. was 19 (29.69%) and 8 (12.5%) respectively, among CD positive samples there was no positive sample for Giardia lamblia . Conclusion: The prevalence of CD among the southwestern Iranian population was high and comparable with other areas of Iran as well as many other countries. Furthermore, no significant association between the presence of T. whipplei , Cryptosporidium spp., and level of the histopathological changes of villi in the CD was observed ( P > 0.05).

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Whipple’s Disease: A Case Report

Cited by 11 publications

References 10 publications

Whipple's Disease (WD) Without Arthropathy in an Immunocompromised Patient

Whipple's Disease (WD) Without Arthropathy in an Immunocompromised Patient

Cutaneous Granulomatosis Revealing Whipple’s Disease: Value of Tropheryma whipplei Polymerase Chain Reaction Assay for the Diagnosis

Molecular detection of Tropheryma whipplei, Cryptosporidium spp., and Giardia lamblia among celiac disease samples

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