Background Whipple's disease is a chronic, systemic, curable bacterial infection, caused by Tropheryma whipplei and often mistaken for rheumatoid arthritis. Indeed, the classical form usually begins with intermittent joint involvement several years before the development of weight loss and diarrhea, associated with other diverse clinical manifestations.
To know the main clinical presentations of Whipple's disease and Tropheryma whipplei localized infections.
To consider a diagnosis of Whipple's disease in a middle-aged man presenting with isolated intermittent arthritis before the development of chronic persistent polyarthritis and of digestive signs and symptoms.
To be able to diagnose Whipple's disease by performing Tropheryma whipplei polymerase chain reaction from stools, saliva and synovial fluid.
To know how to interpret polymerase chain reaction tests and pathological examination results.
To know the therapeutic options in Whipple's disease according to central nervous system involvement.
Methods This presentation describes a patient with a 28-year history of isolated chronic severe bilateral destructive polyarthritis. Blood tests showed elevated acute phase reactants, persistent leukocytosis, but rheumatoid factor and antinuclear antibody tests were negative. He was treated for a presumed seronegative rheumatoid arthritis. He then presented with fever, weight loss, diarrhea and adenopathy.
Results Tropheryma whipplei polymerase chain reaction was positive from synovial fluid, synovial tissue, and lymph node specimens. Duodenal biopsy confirmed periodic acid-Schiff-positive macrophages. Whipple's disease was diagnosed. Tropheryma whipplei was successfully cultivated from the synovial fluid. Antibiotic treatment was instituted in the patient, after which his symptoms remitted.
Conclusions Particular attention to a diagnosis of Tropheryma whipplei infection is warranted in a middle-aged man presenting with unexplained isolated intermittent arthritis. Tropheryma whipplei polymerase chain reaction from stools and saliva should be performed. Antibiotic therapy usually ensures the full resolution of all manifestations, which can otherwise be fatal, in case of late diagnosis of extended systemic forms.
Meunier M, Puéchal X, Hoppé E,et al. Rheumatic and musculoskeletal features of Whipple disease: a report of 29 cases. J Rheumatol 2013;40:2061–6.
Puéchal X. Whipple's disease. Ann Rheum Dis 2013;72:797–803.
Disclosure of Interest None declared