Whipple's disease without malabsorption: new atypical features

QJM : Monthly Journal of the Association of Physicians
S A MisbahN Mapstone

Abstract

The diagnosis of Whipple's disease in the absence of intestinal involvement is difficult and often overlooked. We describe five patients aged 8-71 years with normal jejunal biopsies and disparate clinical features, previously unrecognized in Whipple's; all were investigated at a single institution over a period of 18 months. Routine histological examination for periodic acid-Schiff (PAS) positive macrophages and polymerase chain reaction (PCR) analysis for Tropheryma whippelii was performed on the small intestine in all patients. PCR analysis was also performed on various tissues including peripheral blood, lymph node, muscle, synovium and spleen in individual patients. Patients 1, 2, 4 and 5 had unusual presenting features not previously associated with Whipple's: intractable immune thrombocytopenic purpura (ITP), juvenile chronic arthritis, isolated muscle weakness and quadriparesis, respectively. Patient 3 presented with pyrexia of unknown origin. All patients had histologically normal small-bowel biopsies with no evidence of PAS positive macrophages. PCR for T. whippelii was positive in all patients in one or more tissues: peripheral blood, intestine, muscle, lymph node and synovium. PAS-positive macrophages were found in 4...Continue Reading

Citations

Oct 8, 1999·Arthritis and Rheumatism·I MarieH Courtois
Jul 21, 2000·Arthritis and Rheumatism·P ChérinN Caillat-Vigneron
Aug 30, 2008·Der Nervenarzt·K SpengosP Manta
Sep 12, 2000·Current Gastroenterology Reports·M C Flemmer, R W Flenner
Dec 21, 2000·Current Rheumatology Reports·P Cherin, R K Gherardi
Jan 11, 2003·Current Treatment Options in Gastroenterology·Mark C. Flemmer, Ronald W. Flenner
Jan 28, 2003·Lancet·Thomas Marth, Didier Raoult
Feb 28, 2004·Lancet·Siraj A MisbahChristine Costello
Jun 19, 2001·Neuromuscular Disorders : NMD·P ChérinJ P Leroi
Mar 11, 2000·Neuromuscular Disorders : NMD·T R HelliwellK P Walsh
Jan 5, 2007·The New England Journal of Medicine·Florence FenollarDidier Raoult
Jul 4, 2001·Clinical Microbiology Reviews·F Dutly, M Altwegg
Jun 29, 2002·Journal of Clinical Microbiology·Romana C MaibachMartin Altwegg
Nov 7, 2000·Journal of Clinical Pathology·S A Misbah, N P Mapstone
Sep 29, 2007·Joint, Bone, Spine : Revue Du Rhumatisme·Véronique VincentBernard Fournié
Jun 24, 2011·Journal of the Neurological Sciences·Wazim MohamedSunitha Santhakumar
Jan 20, 2009·Journal of the American Academy of Dermatology·Jörg Schaller, J Andrew Carlson
May 21, 2005·Scandinavian Journal of Rheumatology·J H ParkD H Yoo
Oct 19, 2002·The American Journal of Gastroenterology·Mark Flemmer, Terri Esterowitz
Sep 13, 2006·Muscle & Nerve·Marie PugetNathalie Streichenberger
Jul 27, 1999·Annals of Internal Medicine·J G GublerM Altwegg
Mar 10, 2006·Current Infectious Disease Reports·Klaus MönkemüllerPeter Malfertheiner
Jul 12, 2018·Open Forum Infectious Diseases·Nicholas R CrewsAbinash Virk
Sep 10, 2003·Current Gastroenterology Reports·Florence Fenollar, Didier Raoult
May 7, 2020·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Lola LessardNathalie Streichenberger
Jun 12, 2021·Scientific Reports·Alice TisonAlain Saraux

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