Table Info

Table 2.

Blood tests done later in the course

Lab test	Result	Lab test	Result
ANA	Negative	c-ANCA	Negative
p-ANCA	Negative	Anti-CCP	Negative
RA test	Negative	Myositis panel	Negative
Autoimmune panel	Negative	HIV	Negative
ACE	Negative	PPD skin test	Negative

ANA: antinuclear antibodies; p-ANCA: perinuclear antineutrophil cytoplasmic antibodies; RA: rheumatoid arthritis; ACE: angiotensin converting enzyme; PPD: purified protein derivative; c-ANCA: cytoplasmic antineutrophil cytoplasmic autoantibody; CCP: cyclic citrullinated peptides

Declarations

Author contributions

JF, RC and NS: Writing-original draft. JN and JM: Data collection. JA: Biopsies endoscopy. CG: Interpretation of biopsy results. All authors contributed to revision of manuscript, read and approved the submitted version.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This manuscript has been approved by the Institutional Review Board of Lebanese Hospital Geitaoui.

Consent to participate

Written informed consent was obtained from the patient.

Consent to publication

Not applicable.

Availability of data and materials

All relevant data are contained within the manuscript.

Funding

Not applicable.

Copyright

References

Black-Schaffer B. The tinctoral demonstration of a glycoprotein in Whipple’s disease. Proc Soc Exp Biol Med. 1949;72:225–7. [DOI] [PubMed]

Chears WC Jr, Ashworth CT. Electron microscopic study of the intestinal mucosa in Whipple’s disease. Demonstration of encapsulated bacilliform bodies in the lesion. Gastroenterology. 1961;41:129–38. [DOI] [PubMed]

Wilson KH, Blitchington R, Frothingham R, Wilson JA. Phylogeny of the Whipple’s-disease-associated bacterium. Lancet. 1991;338:474–5. [DOI] [PubMed]

Keita AK, Bassene H, Tall A, Sokhna C, Ratmanov P, Trape JF, et al. Tropheryma whipplei: a common bacterium in rural Senegal. PLoS Negl Trop Dis. 2011;5:e1403. [DOI] [PubMed] [PMC]

Martinetti M, Biagi F, Badulli C, Feurle GE, Müller C, Moos V, et al. The HLA alleles DRB1^*13 and DQB1^*06 are associated to Whipple’s disease. Gastroenterology. 2009;136:2289–94. [DOI] [PubMed]

Feurle GE. Association of Whipple’s disease with HLA-B27. Lancet. 1985;325:1336. [DOI] [PubMed]

Biagi F, Balduzzi D, Delvino P, Schiepatti A, Klersy C, Corazza GR. Prevalence of Whipple’s disease in north-western Italy. Eur J Clin Microbiol Infect Dis. 2015;34:1347–8. [DOI] [PubMed]

Ojeda E, Cosme A, Lapaza J, Torrado J, Arruabarrena I, Alzate L. Whipple’s disease in Spain: a clinical review of 91 patients diagnosed between 1947 and 2001. Rev Esp Enferm Dig. 2010;102:108–23. [DOI] [PubMed]

Elchert JA, Mansoor E, Abou-Saleh M, Cooper GS. Epidemiology of Whipple’s disease in the USA between 2012 and 2017: a population-based national study. Dig Dis Sci. 2019;64:1305–11. [DOI] [PubMed] [PMC]

10.

Fleming JL, Wiesner RH, Shorter RG. Whipple’s disease: clinical, biochemical, and histopathologic features and assessment of treatment in 29 patients. Mayo Clin Proc. 1988;63:539–51. [DOI] [PubMed]

11.

Dobbins WO 3rd. The diagnosis of Whipple’s disease. N Engl J Med. 1995;332:390–2. [DOI] [PubMed]

12.

Keita AK, Raoult D, Fenollar F. Tropheryma whipplei as a commensal bacterium. Future Microbiol. 2013;8:57–71. [DOI] [PubMed]

13.

Ramzan NN, Loftus E Jr, Burgart LJ, Rooney M, Batts KP, Wiesner RH, et al. Diagnosis and monitoring of Whipple disease by polymerase chain reaction. Ann Intern Med. 1997;126:520–7. [DOI] [PubMed]

14.

Braun J, Sieper J. Rheumatologic manifestations of gastrointestinal disorders. Curr Opin Rheumatol. 1999;11:68–74. [DOI] [PubMed]

15.

Lagier JC, Lepidi H, Raoult D, Fenollar F. Systemic Tropheryma whipplei: clinical presentation of 142 patients with infections diagnosed or confirmed in a reference center. Medicine. 2010;89:337–45. [DOI] [PubMed]

16.

Moreno García MS, Casorrán Berges M, Del Río-Martínez PS, Bosque Peralta MT. The great unknown, Whipple’s disease. Reumatol Clin. 2017;13:243–4. [DOI] [PubMed]

17.

Durand DV, Lecomte C, Cathébras P, Rousset H, Godeau P; the SNFMI Research Group on Whipple Disease. Whipple disease: clinical review of 52 cases. Medicine. 1997;76:170–84. [DOI] [PubMed]

18.

Mahnel R, Kalt A, Ring S, Stallmach A, Strober W, Marth T. Immunosuppressive therapy in Whipple’s disease patients is associated with the appearance of gastrointestinal manifestations. Am J Gastroenterol. 2005;100:1167–73. [DOI] [PubMed]

19.

Parkash V, Mudhar HS, Wagner BE, Raoult D, Batty R, Lepidi H, et al. Bilateral ocular myositis associated with Whipple’s disease. Ocul Oncol Pathol. 2017;3:17–21. [DOI] [PubMed] [PMC]

20.

Ankli B, Khanlari B, Pegios V, Zettl A, Daikeler T. Whipple’s disease mimicking an auto-inflammatory disease with myositis and soft tissue inflammation. Joint Bone Spine. 2018;85:645–6. [DOI] [PubMed]

21.

Louis ED, Lynch T, Kaufmann P, Fahn S, Odel J. Diagnostic guidelines in central nervous system Whipple’s disease. Ann Neurol. 1996;40:561–8. [DOI] [PubMed]

22.

Gerard A, Sarrot-Reynauld F, Liozon E, Cathebras P, Besson G, Robin C, et al. Neurologic presentation of Whipple disease: report of 12 cases and review of the literature. Medicine. 2002;81:443–57. [DOI] [PubMed]

23.

Lieb K, Maiwald M, Berger M, Voderholzer U. Insomnia for 5 years. Lancet. 1999;354:1966. [DOI] [PubMed]

24.

Tison A, Preuss P, Leleu C, Robin F, Le Pluart A, Vix J, et al. Rheumatological features of Whipple disease. Sci Rep. 2021;11:12278. [DOI] [PubMed] [PMC]

25.

Whipple Disease [Internet]. Musculosketal Key; [cited 2022 Sep 16]. Available from: https://musculoskeletalkey.com/whipples-disease/

26.

Marth T. Whipple’s disease. Acta Clin Belg. 2016;71:373–8. [DOI] [PubMed]

27.

Fenollar F, Puéchal X, Raoult D. Whipple’s disease. N Engl J Med. 2007;356:55–66. [DOI] [PubMed]

28.

Lagier JC, Fenollar F, Lepidi H, Giorgi R, Million M, Raoult D. Treatment of classic Whipple’s disease: from in vitro results to clinical outcome. J Antimicrob Chemother. 2014;69:219–27. [DOI] [PubMed]

29.

Guthikonda B, Rouah E, Krishnan B, Powell SZ, Goodman JC, Gopinath SP, et al. Whipple disease of the central nervous system: an unusual occurrence in association with acquired immune deficiency syndrome. J Neurosurg. 2010;112:983–9. [DOI] [PubMed]

30.

Dolmans RA, Boel CH, Lacle MM, Kusters JG. Clinical manifestations, treatment, and diagnosis of Tropheryma whipplei infections. Clin Microbiol Rev. 2017;30:529–55. [DOI] [PubMed] [PMC]

31.

Marth T. Systematic review: Whipple’s disease (Tropheryma whipplei infection) and its unmasking by tumour necrosis factor inhibitors. Aliment Pharmacol Ther. 2015;41:709–24. [DOI] [PubMed]

32.

Obst W, von Arnim U, Malfertheiner P. Whipple’s disease. Viszeralmedizin. 2014;30:167–72. [DOI] [PubMed] [PMC]

33.

Rey RM, Orozco LA, Marrugo K, López R, Pérez-Riveros ED, De la Hoz-Valle J, et al. Whipple disease diagnosed by enteroscopy: first case report in Colombia of an underdiagnosed disease and literature review. BMC Gastroenterol. 2020;20:197. [DOI] [PubMed] [PMC]

34.

Wartique L, Lagier JC, Raoult D, Jamilloux Y, Sève P. Mesenteric lymphadenitis as a presenting feature of Whipple’s disease: value of PCR analysis. Int J Infect Dis. 2018;75:15–7. [DOI] [PubMed]

35.

Keinath RD, Merrell DE, Vlietstra R, Dobbins WO 3rd. Antibiotic treatment and relapse in Whipple’s disease. Long-term follow-up of 88 patients. Gastroenterology. 1985;88:1867–73. [DOI] [PubMed]