Clinical Rheumatology

, Volume 22, Issue 6, pp 443–446

Spondylodiscitis as the first manifestation of Whipple’s disease –a removal worker with chronic low back pain

  • U. Weber
  • M. H. Morf
  • J. G. H. Gubler
  • M. Altwegg
  • R. C. Maibach
Case Report

DOI: 10.1007/s10067-003-0786-2

Cite this article as:
Weber, U., Morf, M.H., Gubler, J.G.H. et al. Clin Rheumatol (2003) 22: 443. doi:10.1007/s10067-003-0786-2

Abstract

Whipple’s disease is a rare systemic infectious disease caused by the actinobacterium Tropheryma whipplei. Spondylodiscitis is an extremely rare manifestation of the infection and has previously been described in only three case reports. We present a 55-year-old man with persistent lumbago and signs of systemic illness, but without any gastrointestinal symptoms or arthralgia. The signal response in the lumbar spine in magnetic resonance tomography, both native and after intravenous gadolinium administration, was compatible with spondylodiscitis at the L4/L5 level. Culture of a specimen obtained by radiographically guided disc puncture and repeated blood cultures remained sterile. Tropheryma whipplei was detected by PCR amplification in material obtained from the disc specimen, from a biopsy of the terminal ileum and from the stool. The histology of duodenum, terminal ileum, colon and disc material was normal and, in particular, showed no PAS-positive inclusions in macrophages. Long-term antibiotic treatment with sulphamethoxazole and trimethoprim was successful, with marked improvement of the low back pain and normalisation of the systemic inflammatory signs. The possibility of Whipple’s disease must be suspected in the case of a ‘culture-negative’ spondylodiscitis even if there are no gastrointestinal symptoms and no arthralgia present.

Keywords

Low back painSpondylodiscitisWhipple’s disease

Abbreviations

PAS

Periodic acid–Schiff

PCR

Polymerase chain reaction

PSA

Prostate-specific antigen

EDTA

Ethylene diamine tetra-acetic acid

Copyright information

© Clinical Rheumatology 2003

Authors and Affiliations

  • U. Weber
    • 1
  • M. H. Morf
    • 2
  • J. G. H. Gubler
    • 3
  • M. Altwegg
    • 4
  • R. C. Maibach
    • 4
  1. 1.Physical Medicine and RheumatologyBalgrist University HospitalZürichSwitzerland
  2. 2.Department of Rheumatology and RehabilitationTriemli City HospitalZürichSwitzerland
  3. 3.Department of MedicineTriemli City HospitalZürichSwitzerland
  4. 4.Institute of Medical MicrobiologyUniversity of ZürichZürichSwitzerland