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

Loughran, Dafydd; Beale, Lee; Lodge, Freya; Habboush, H.W.; Stock, David

doi:10.1136/jclinpath-2013-201915

Cited by 10 publications

(11 citation statements)

References 7 publications

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“…There is an association between thrombocytopenia and T. whipplei infection, which probably results from peripheral platelet sequestration. This thrombocytopenia rapidly resolves upon treatment (138). Finally, ocular manifestations have been described (145), and crystalline keratopathy has been reported as a typical characteristic of ocular Whipple's disease (146).…”

Section: Classic Whipple's Diseasementioning

confidence: 96%

“…Especially in the early phase of the disease, several less common symptoms of Whipple's disease can become manifest (Table 3) (120,(134)(135)(136)(137)(138). Dermatologists should be aware that both cutaneous (10, 139) and subcutaneous (140-143) lesions may be a manifestation of Whipple's disease, as cutaneous biopsy specimens containing PAS-positive macrophages characteristic of Whipple's disease have been reported (136).…”

Section: Classic Whipple's Diseasementioning

confidence: 99%

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Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

et al. 2017

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SUMMARY Whipple's disease is a rare infectious disease that can be fatal if left untreated. The disease is caused by infection with Tropheryma whipplei, a bacterium that may be more common than was initially assumed. Most patients present with nonspecific symptoms, and as routine cultivation of the bacterium is not feasible, it is difficult to diagnose this infection. On the other hand, due to the generic symptoms, infection with this bacterium is actually quite often in the differential diagnosis. The gold standard for diagnosis used to be periodic acid-Schiff (PAS) staining of duodenal biopsy specimens, but PAS staining has a poor specificity and sensitivity. The development of molecular techniques has resulted in more convenient methods for detecting T. whipplei infections, and this has greatly improved the diagnosis of this often missed infection. In addition, the molecular detection of T. whipplei has resulted in an increase in knowledge about its pathogenicity, and this review gives an overview of the new insights in epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of Tropheryma whipplei infections.

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Section: Classic Whipple's Diseasementioning

confidence: 96%

Section: Classic Whipple's Diseasementioning

confidence: 99%

Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

et al. 2017

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“…Long term corticosteroid treatment is designed to suppress host immunity, and could also mask symptoms. Patients who are undiagnosed and therefore untreated have an 80% 5-year survival rate after onset of arthralgia, but only 20% 5-year survival after the onset of diarrhea or abdominal pain [3]. It appears to be even lower after the development of thrombocytopenia and endocarditis [3].…”

Section: Discussionmentioning

confidence: 99%

“…Patients who are undiagnosed and therefore untreated have an 80% 5-year survival rate after onset of arthralgia, but only 20% 5-year survival after the onset of diarrhea or abdominal pain [3]. It appears to be even lower after the development of thrombocytopenia and endocarditis [3]. 1 month after his initial visit an EGD and colonoscopy were negative but histology with periodic acid-Schiff [PAS] staining was omitted and therefore an opportunity missed.…”

Section: Discussionmentioning

confidence: 99%

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Thrombocytopenia and endocarditis in a patient with Whipple’s disease: case report

et al. 2020

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Background: Whipple's disease (WD) is a rare multisystem infectious disorder that is caused by the actinomycete Tropheryma whipplei. It presents with joint pain followed by abdominal pain, diarrhea, malabsorption and finally failure to thrive. Diagnosis requires tissue sampling and histology with periodic acid-Schiff [PAS] staining. Thrombocytopenia associated with endocarditis associated with WD has been reported twice. Case presentation: A 56 year old Caucasian male presented with years of steroid treated joint pain and recent onset diarrhea, weight loss and abdominal pain. Ultimately he was found to have a platelet count of 4000 with concomitant endocarditis and embolic stroke. Small bowel biopsy confirmed the diagnosis of WD approximately 1 year after his first visit. His platelets improved with antibiotic treatment but he eventually expired 16 months after his initial consult and 5 months after his definitive diagnosis. Conclusion: WD can remain undiagnosed and untreated until late in the course of the illness. A high index of suspicion is recognized as necessary for early diagnosis to begin treatment. Critical thrombocytopenia associated with endocarditis is a rare and potentially poor prognostic sign in late stage Whipple's disease.

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Quantitative changes in blood cells

2021

Blood Cells

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

Cited by 10 publications

References 7 publications

Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

Thrombocytopenia and endocarditis in a patient with Whipple’s disease: case report

Quantitative changes in blood cells

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