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Fever of unknown origin with seronegative spondyloarthropathy: an atypical manifestation of Whipple's disease
  1. C Várvölgyi1,
  2. T Bubán1,
  3. S Szakáll2,
  4. Z Hargitai2,
  5. L Galuska3,
  6. C Jeney4,
  7. G Kakuk1,
  8. J Gaál1
  1. 1Ist Department of Internal Medicine, University of Debrecen, Medical and Health Science Centre, Debrecen, Hungary
  2. 2Institute of Pathology, University of Debrecen
  3. 3Department of Nuclear Medicine, University of Debrecen
  4. 4H-MED Laboratory, Central Military Hospital, Budapest, Hungary
  1. Correspondence to:
    Dr J Gaál, Ist Department of Internal Medicine, University of Debrecen, Medical and Health Science Centre, Debrecen, 4012 Hungary, POB 19;
    gaalj{at}ibel.dote.hu

https://doi.org/10.1136/ard.61.4.377

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    Many authors emphasise the diagnostic difficulties and point out the multifaceted nature of Whipple's disease.1,2 Joint symptoms are present in 90% of all cases and may precede other disease manifestations by decades.3 We report here a case with fever of unknown origin accompanied by seronegative spondyloarthropathy with no typical gastrointestinal symptoms and initially negative upper panendoscopy. To confirm the diagnosis, the bacterial 16S ribosomal RNA sequence of Tropheryma whippelii was determined by polymerase chain reaction (PCR).

    CASE REPORT

    A 58 year old white man had a 12 year history of intermittent arthralgias and seronegative polyarthritis. In 1993, monolateral stage II sacroiliitis was disclosed with no definite cause. Low dose methylprednisolone treatment was started, but there was no clinical improvement. In 1998 the patient became febrile, lost 10 kg of weight but had no gastrointestinal symptoms. He underwent an extensive examination, including radiological examinations of the chest and paranasal sinuses, abdominal sonography, echocardiography, abdominal computed tomography, upper panendoscopy, bone marrow biopsies, whole body gallium-67 citrate scan, multiple blood, stool, and urine cultures, as well as serological investigations for known …

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