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Limbic encephalitis as a relapse of Whipple’s disease with digestive involvement and spondylodiscitis

  • Didier BrönnimannEmail author
  • Marc-Olivier Vareil
  • Igor Sibon
  • Jean-Christophe Lagier
  • Hubert Lepidi
  • Mathilde Puges
  • Fatiha Haneche
  • Didier Raoult
  • Arnaud Desclaux
  • Didier Neau
  • Charles Cazanave
Case Report



Many clinical manifestations can be related to Tropheryma whipplei infection.

Case report

We report a Tropheryma whipplei limbic encephalitis developed as a relapse of classical Whipple’s disease.


This case is to the best of our knowledge the first proof of the effective brain–blood barrier crossing of both doxycycline and hydroxychloroquine as demonstrated by direct concentration monitoring on brain biopsy.


Tropheryma whipplei Whipple’s disease Limbic encephalitis Emerging infectious disease 



We thank the patient for participating. We also thank Pr. Ph. FERNANDEZ for brain 18F-FDG-PET picture, and Dr. Pantxika BELLECAVE, for technical assistance.

Author contributions

Dr. DB and Pr. CC had full access to all the data in the study and takes responsibility for the integrity of the data. Study concept and design: DB, IS, DN, CC. Acquisition, analysis, or interpretation of data: all authors. Drafting of the manuscript: BB, CC, AD. Critical revision of the manuscript for important intellectual content: DB, IS, JL, HL, DR, DN, CC. Administrative, technical, or material support: DB, MP, FH. Study supervision: CC.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Didier Brönnimann
    • 1
    Email author
  • Marc-Olivier Vareil
    • 2
  • Igor Sibon
    • 3
    • 4
  • Jean-Christophe Lagier
    • 5
  • Hubert Lepidi
    • 5
  • Mathilde Puges
    • 6
  • Fatiha Haneche
    • 6
  • Didier Raoult
    • 5
  • Arnaud Desclaux
    • 6
  • Didier Neau
    • 6
  • Charles Cazanave
    • 6
    • 7
  1. 1.Service de médecine interne et pathologies infectieusesCHU de Bordeaux, Groupe Hospitalier Saint André, hôpital Saint AndréBordeaux CedexFrance
  2. 2.Service de maladies infectieuses et dermatologieCentre hospitalier de la côte basqueBayonneFrance
  3. 3.CHU Bordeaux, Unité NeurovasculaireBordeauxFrance
  4. 4.Univ. Bordeaux, INCIA UMR CNRS 5287BordeauxFrance
  5. 5.Aix Marseille Université, URMITE, UM 63, CNRS 7278, IRD 198, INSERM 1095MarseilleFrance
  6. 6.Service des pathologies infectieuses et tropicalesCHU de Bordeaux, hôpital PellegrinBordeauxFrance
  7. 7.Univ. Bordeaux, USC EA 3671, Infections humaines à mycoplasmes et à chlamydiaeBordeauxFrance

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