REVIEW PAPER
Clinical manifestations of Whipple’s disease mimicking rheumatic disorders
1
Department of Internal Medicine, Rheumatology and Clinical Immunology, Medical University of Silesia, Katowice, Poland
Submission date: 2021-01-20
Final revision date: -0001-11-30
Acceptance date: 2021-03-31
Online publication date: 2021-04-27
Publication date: 2021-04-28
Reumatologia 2021;59(2):104-110
KEYWORDS
TOPICS
ABSTRACT
Whipple’s disease is a rare, chronic, systemic disorder caused by Tropheryma whipplei infection. The most common symptoms are weight loss, arthralgia, diarrhea and abdominal pain. Other organ involvement can also occur in the patients. Joint manifestations may mimic rheumatoid arthritis or spondyloarthritis. Arthalgia, arthritis, spondylodiscitis, bursitis and/or tenosynovitis are seen in the majority of the patients. This explains why some of the symptoms are misdiagnosed as those of rheumatic diseases. Understanding of Whipple’s disease is important for differential diagnostics of several rheumatic symptoms.
REFERENCES (56)
1.
Allchin WH, Hebb RG. Lymphangiectasis intestine. Trans Path Soc (London) 1895; 46: 221–223.
2.
Whipple GH. A hitherto undescribed disease characterized anatomically by deposits of fat and fatty acids in the intestinal and mesenteric lymphatic tissues. Bull Johns Hopkins Hosp 1907; 18: 3582–391.
3.
Black-Schaffer B. The tinctorial demonstration of a glycoprotein in Whipple’s disease. Proc Soc Exp Biol Med 1949; 72: 225–227.
4.
Paulley JW. A case of Whipple’s disease (interstinal lipodystrophy). Gastroenterology 1952; 22: 128–132.
5.
Cohen AS, Schimmel EM, Holt PR, Isselbacher KJ. Ultrastructural abnormalities in Whipple’s disease. Proc Soc Exp Biol Med 1960; 105: 411–414, DOI: 10.3181/00379727-105-26126.
6.
Chears WC, Ashwortj CT. Electron microscopy study of the interstitial mucosa in Whipple’s disease: demonstration of encapsulated bacilliform bodies in the lesion. Gastroenterology 1961; 41: 129–138.
7.
Wilson KH, Blitchington R, Frothingham R, Wilson JA. Phylogeny of the Whipple’s-disease-associated bacterium. Lancet 1991; 338: 474–475, DOI: 10.1016/0140-6736(91)90545-z.
8.
Relman DA, Schmidt TM, MacDermott RP, Falkow S. Identification of the uncultured bacillus of Whipple’s disese. N Engl J Med 1992; 327: 293–301, DOI: 10.1056/NEJM199207303270501.
9.
La Scola B, Fenollar F, Fournier PE, et al. Description of Tropheryma whipplei gen. nov., sp. nov., the Whipple’s disease bacillus. Int J Syst Evol Microbiol 2001; 51 (Pt 4): 1471–1479, DOI: 10.1099/00207713-51-4-1471.
10.
Schoedon G, Goldenberger D, Forrer R, et al. Deactivation of macrophages with IL-4 is the key to isolation of Tropheryma whippelii. J Infect Dis 1997; 176: 672–677, DOI: 10.1086/514089.
11.
Raoult D, Birg ML, La Scola B, et al. Cultivation of the bacillus of Whipple’s disease. N Engl J Med 2000; 342: 620–625, DOI: 10.1056/NEJM200003023420903.
12.
Wysocki WM, Komorowski AL, Wysocki A. Jedno nazwisko, dwóch lekarzy, czyli o metodzie Whipple’a i chorobie Whipple’a. Przegl Lek 2005; 62: 139–140.
13.
Sharma OP. Beethoven’s illness: Whipple’s disease rather than sarcoidosis? J Roy Soc Med 1994; 87: 283–285.
15.
Dutly F, Altwegg M. Whipple’s disease and Tropheryma whippelii. Clin Microbiol Rev 2001; 14: 561–583, DOI: 10.1128/CMR.14.3.561-583.2001.
16.
Keita AK, Mediannikov O, Ratmonov P, et al. Looking for Tropheryma whipplei source and reservoir in rural Senegal. Am J Trop Med Hyg 2013; 88: 339–343, DOI: 10.4269/ajtmh.2012.12-0614.
17.
Keita AK, Dubot-Pérès A, Phommasone K, et al. High prevalence of Tropheryma whipplei in Lao kindergarten children. PLoS Negl Trop Dis 2015; 9: e0003538, DOI: 10.1371/journal.pntd.0003538.
18.
Biagi F, Balduzzi D, Delvino P, et al. Prevalence of Whipple’s disease in north-western Italy. Eur J Clin Microbiol Infect Dis 2015; 34: 1347–1348, DOI: 10.1007/s10096-015-2357-2.
19.
Elchert JA, Mansoor E, Abou-Saleh M, Cooper GS. Epidemiology of Whipple’s disease in the USA between 2012 and 2017: a populations-based national study. Dig Dis Sci 2019; 64: 1305–1311, DOI: 10.1007/s10620-018-5393-9.
20.
Schneider T, Moos V, Loddenkemper C, et al. Whipple’s disease: new aspects of pathogenesis and treatment. Lancet Infect Dis 2008; 8: 179–190, DOI: 10.1016/S1473-3099(08)70042-2.
21.
Misbah SA, Mapstone NP. Whipple’s disease revisited. J Clin Pathol 2000; 53: 750–755, DOI: 10.1136/jcp.53.10.750.
22.
Van Kruiningen HJ, Dobbins WO, John G. Bacterial histiocytic colitis in a lowland gorilla (Gorilla Gorilla gorilla). Vet Pathol 1991; 28: 544–546, DOI: 10.1177/030098589102800616.
23.
Van Kruiningen HJ, Montali RJ, Strandberg JD, Kirk RW. A granulomatous colitis of dogs with histological resemblance of Whipple’s disease. Pathol Vet 1965; 2: 521–544, DOI: 10.1177/ 030098586500200601.
24.
El-Abassi R, Soliman MY, Williams F, England JD. Whipple’s disease. J Neurol Sci 2017; 377: 197–206, DOI: 10.1016/j.jns.2017. 01.048.
25.
Maiwald M, Ditton A, von Herbay FA, et al. Reassessment of the phylogenetic position of the bacterium associated with Whipple’s disease and determination of the 16S-23S ribosomal intergenic spacer sequence. Int J Syst Bacteriol 1996; 46: 1078–1082, DOI: 10.1099/00207713-46-4-1078.
26.
Berthelot J-M, Puéchal X. Impaired intracellular pathogen clearance and inflammatory joint disease: is Whipple’s disease a guiding light? Joint Bone Spine 2018; 85: 531–536, DOI: 10.1016/j.jbspin.2017.09.007.
27.
Dolmans RAV, Boel CH, Lacie MM, Kusters JG. Clinical manifestation, treatment, and diagnosis of Tropheryma whipplei infections. Clin Microbiol Rev 2017; 30: 529–553, DOI: 10.1128/CMR.00033-16.
28.
Compain C, Sacre K, Puéchal X, et al. Central nervous system involvement in Whipple disease. Clinical study of 18 patients and long-term follow-up. Medicine (Baltimore) 2013; 92: 324–330, DOI: 10.1097/MD.0000000000000010.
29.
Kilani M, Njim L, Nsir AB, Hattab MN. Whipple disease presenting as cystic brain tumor case report and review of the literature. Turk Neurosurg 2018; 28: 495–499, DOI: 10.5137/1019-5149.JTN.17111-16.2.
30.
Hurth K, Tarawneh R, Ghoshal N, et al. Whipple’s disease masquerades as dementia with Lewy bodies. Alzheimer Dis Assoc Disord 2015; 29: 85–89, DOI: 10.1097/WAD.0b013e3182a715da.
31.
Chandra SR, Raj P, Pai AR, Reddy N. A case of Whipple’s disease: a very rare cause for rapidly progressive dementia. Indian J Psychol Med 2018; 40: 280–283, DOI: 10.4103/IJPSYM.IJPSYM_ 149_17.
32.
Puéchal X. Whipple disease and arthritis. Curr Opin Rheumatol 2001; 13: 74–79, DOI: 10.1097/00002281-200101000-00012.
33.
Krol CG, de Meijer PH. Palindromic rheumatism consider Whipple’s disease. Int J Rheum Dis 2013; 16: 475–476, DOI: 10.1111/1756-185X.12084.
34.
Puéchal X. Whipple’s disease. Ann Rheum Dis 2013; 72: 797–803, DOI: 10.1136/annrheumdis-2012-202684.
35.
Rosa da Silva GA, Pires Neto JS. Whipple’s disease manifested as difficult-to-diagnose polyarthralgia: a case report and literature review. Rev Bras Rheumatol (England Ed) 2017; 57: 483–48, DOI: 10.1016/j.rbre.2015.05.003.
36.
Glaser C, Rieg S, Wiech T, et al. Whipple’s disease mimicking rheumatoid arthritis can cause misdiagnosis and treatment failure. Orphanet J Rare Dis 2017; 12: 99, DOI: 10.1186/s13023-017-0630-4.
37.
Dubost JJ, Couderc M, Mathien S, et al. Chronic bursitis and tenosynovitis revealing Whipple’s disease. Joint Bone Spine 2020; 87: 481–482, DOI: 10.1016/j.jbspin.2020.01.010.
38.
Feurle GE. Association of Whipple’s disease with HLA-B27. Lancet 1985; 325: 1336, DOI: 10.1016/s0140-6736(85)92831-4.
39.
Martins MDL, Abreu P, Caldeira A, et al. Whipple disease and ankylosing spondylitis – a case report. J Clin Rheumatol 2020, DOI: 10.1097/RHU.0000000000001466 [Online ahead of print].
40.
Ramos JM, Pasquau F, Galipienso N, et al. Whipple’s disease diagnosed during anti-tumor necrosis factor alpha treatment: two case reports and review of the literature. J Med Case Rep 2015; 9: 165, DOI: 10.1186/s13256-015-0632-6.
41.
Estévez-Gil M, de Castro-Parga ML, Carballo-Fernandez C, et al. Whipple disease in a patient under anti-TNF-αlpha therapy. Gastroenterol Hepatol 2016; 39: 334–335, DOI: 10.1016/j.gastrohep.2015.04.005.
42.
Sparsa L, Fenollar F, Gossec L, et al. Whipple disease revealed by anti-TNF therapy. Rev Med Interne 2013; 34: 105–109, DOI: 10.1016/j.revmed.2012.10.371 [Article in French].
43.
Gaddy JR, Khan ZZ, Chaser B, Scofield RH. Whipple’s disease diagnosis following the use of TNF-αlpha blockade. Rheumatology (Oxford) 2012; 51: 946, DOI: 10.1093/rheumatology/ker387.
44.
Hoppé E, Masson C, Audran M, et al. Whipple’s disease diagnosed during biological treatment for joint disease. Joint Bone Spine 2010; 77: 335–339, DOI: 10.1016/j.jbspin.2010.03.015.
45.
Sève P, Kodjikian L, Adélaïde L, Jamilloux Y. Uveitis in adults: What do rheumatologists need to know? Joint Bone Spine 2015; 82: 308–314, DOI: 10.1016/j.jbspin.2015.06.002.
46.
Parkash V, Mudhar HS, Wagnere BE, et al. Bilateral ocular myositis associated with Whipple’s disease. Ocul Oncol Pathol 2017; 3: 17–21, DOI: 10.1159/000448622.
47.
Walter R, Bachmann SP, Schaffner A, et al. Bone marrow involvement in Whipple’s disease: rarely reported, but really rare? Br J Haematol 2001; 112: 677–679, DOI: 10.1046/j.1365-2141.2001.02648.x.
48.
Pérez Álvarez Ál, Moris de la Tassa G. Cervical myelopathy as a form of presentation of Whipple disease. Neurología 2019; 35: 583–585, DOI: 10.1016/j.nrl.2019.03.007.
49.
Weber U, Morf MH, Gubler JG, et al. Spondylodiscitis as the first manifestation of Whipple’s disease in a removal worker with chronic low back pain. Clin Rheumatol 2003; 22: 443–446, DOI: 10.1007/s10067-003-0786-2.
50.
Mirsbrunner-Erni R, Altwegg M, Diener PA, Vilinger PM. Whipple’s disease with normal intestinal histology: rarity or reality? Schweiz Med Wschr 2000; 130: 1820–1826.
51.
Whistance RN, Elfarouki GW, Vohra HA, Livesey SA. A case of Tropheryma whipplei infective endocarditis of the aortic and mitral valves in association with psoriatic arthritis and lumbar discitis. J Heart Valve Dis 2011; 20: 353–356.
52.
Totschnig D, Seitz T, Zoufaly A, et al. Whipple’s disease diagnosed in a patient with suspected sarcoidosis. Int J Infect Dis 2021; 22: S1201-9712(21)00271-X, DOI: 10.1016/j.ijid.2021. 03.053 [Online ahead of print].
53.
Melas N, Amin R, Gyllemark P, et al. Whipple’s disease: the great masquerader – a high level of suspicion is the key to diagnosis. BMC Gastroenterol 2021; 21: 128, DOI: 10.1186/s12876-021-01664-1.
54.
Feurle GE, Moos V, Stroux A, et al. Differential diagnostic value of rheumatic symptoms in patients with Whipple’s disease. Sci Rep 2021; 11: 5980, DOI: 10.1038/s41598-021-85217-2.
55.
Ruggiero E, Zurio A, Giantin V, et al. Relapsing Whipple’s disease: a case report and literature review. Eur J Gastroenterol Hepatol 2016; 28: 267–270, DOI: 10.1097/MEG.0000000000000539.
56.
Nabeya D, Kinjo T, Yamaniha K, et al. Use of steroids to treat anti-tumor necrosis factor induced tuberculosis-associated immune reconstitution inflammatory syndrome: case report and literature review. Medicine (Baltimore) 2020; 99: e22076, DOI: 10.1097/MD.0000000000022076.
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