Whipple's disease. Report of five cases with different clinical features

Abstract

Whipple's disease (WD) is a rare systemic disease of infectious etiology which involves the small intestine but can virtually affect any organ. We present here five cases (four males and one female) ranging in age from 20 to 59 years. All patients had intestinal involvement associated or not with clinical manifestations linked to this organ. Vegetation in the tricuspid valve was observed in one patient, suggesting endocarditis caused by Tropheryma whippelii, with disappearance of the echocardiographic alterations after treatment. In one of the male patients the initial clinical manifestation was serologically negative spondylitis, with no diarrhea occurring at any time during follow-up. Ocular involvement associated with intestinal malabsorption and significant weight loss were observed in one case. In the other two cases, diarrhea was the major clinical manifestation. All patients were diagnosed by histological examination of the jejunal mucosa and, when indicated, of extraintestinal tissues by light and electron microscopy. After antibiotic treatment, full remission of symptoms occurred in all cases. A control examination of the intestinal mucosa performed after twelve months of treatment with sulfamethoxazole-trimethoprim revealed the disappearance of T. whippelii in four patients. The remaining patient was lost to follow-up.

Tropheryma whipplei tricuspid endocarditis: a case report and review of the literature

“…A tricuspid endocarditis associated with involvement of other valves (mostly aortic) is reported in 6% of cases [4]. To the best of our knowledge, only one case of a patient diagnosed with Tropheryma whipplei tricuspid endocarditis without any other valve involved has been completely reported [13]. It describes the case of a young female presenting with migratory arthralgia, abdominal pain, diarrhea, and weight loss of two years duration.…”

“…The diagnosis of Whipple's disease was made on jejunal biopsy by electron microscopy and transoesophageal echocardiogram revealed a fixed vegetation on the tricuspid valve. The patient was successfully treated with penicillin G and streptomycin for 14 days, followed by sulfamethoxazole-trimethoprim for one year [13]. No surgery involving the valve was carried out.…”

“…who presented symptoms (arthralgia and digestive involvement) suggestive of Whipple's disease [13], our patient presented a Tropheryma whipplei endocarditis manifesting as severe shock. Apart from weight loss, he didn't exhibit any of the typical symptoms of Whipple's disease.…”

Premature ovarian failure in suspected Whipple's disease

“…The ovarian localization of T. whippelii has never been reported because of the rarity of this illness, but it may be possible according to the systemic diffusion of the pathogen and its tropism for many tissues (8).…”

Whipple's in the valleys: a case of Whipple's with thrombocytopenia and endocarditis

“…Endocarditis predominantly affects the mitral and aortic valves. Two cases of tricuspid valve endocarditis without classical abdominal symptoms have been previously described in the literature 6 7…”