Summary
Report is given on a 68-year-old man who suffered primarily from progressive weight loss and repeated episodes of fever and arthralgia. Later, liver dysfunction and renal insufficiency developed. Liver and kidney biopsics disclosed granulomatous hepatitis and nephritis. Because of the morphologic and clinical findings, the diagnosis of Boeck's disease was made. Shortly before death, diarrhea developed. Autopsy revealed a massive systemic involvement in Whipple's disease proven by light and electron microscopy and immunofluorescence. Tuberculoid and epitheloid cell granulomas and isolated giant cells were found in addition to the biopsy findings in skeleton muscles, the small intestine, lymphnodes and bronchi. At autopsy, the kidney showed chronic interstitial nephritis. The literature of kidney involvement in Whipple's disease is reviewed. This is the first case with granulomatous interstitial nephritis and chronic renal insufficiency in an inadequately treated Whipple's disease.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Whipple GH (1907) A hitherto undescribed disease characterized anatomically by deposits of fat and fatty acids in the intestinal mesenteric lymphatic tissues. Bull Johns Hopkins Hospital 18:382–390
Chears WC Jr, Ashworth CT (1961) Electronmicroscopic study of the intestinal mucosa in Whipple's disease — demonstration of encapsulated bacilliform bodies in the lesion. Gastroenterology 41:129–138
Yardley JH, Hendrix TR (1961) Combined electron- and light-microscopy in Whipple's disease — demonstration of “bacillary bodies” int he intestine. Bull Johns Hopkins Hospital: 109:80–98
Zollinger HU, Mihatsch MJ (1978) Renal pathology in biopsy. Springer, Berlin Heidelberg New York
Denk H, Syré G, Weirich E (1977) Immunomorphologic methods in routine pathology. Application of immunofluorescence and the unlabeled antibody-enzyme (peroxidase-antiperoxidase) technique to formaline fixed paraffin embedded kidney biopsies. Beitr Pathol 160:187–194
Kent SP, Palmer M, Kirkpatrick PM (1980) Whipple's discase: immunological and histochemical studies of eight cases. Arch Pathol Lab Med 104:514–547
Sieracki JC (1958) Whipple's disease — observation on systemic involvement I. Arch Pathol 66:464–467
Sieracki JC, Fine G (1959) Whipple's disease — observation on systemic involvement II. Arch. Pathol 67:81–93
Miksche LW, Blümcke S, Fritsche D, Küchemann K, Schüler HW, Grözinger KH (1974) Whipple's disease: etiopathogenesis, treatment diagnosis, and clinical course. Case report and review of the world literature. Acta Hepatogastroenterolog (Stuttg) 21:307–326
Maizel H, Ruffix JM, Dobbins WO (1970) Whipple's disease: a review of 19 patients from one hospital and a review of the literature since 1950. Medicine 49/3:175–205
Swash M, Schwartz MS, Vandenburg MJ, Pollock DJ (1977) Myopathy in Whipple's disease. Gut 18:800–804
Barbaryka I, Thorn L, Langer E (1979) Epitheloid cell granulomata in the mucosa of the small intestine in Whipple's disease. Virchow's Arch [Pathol Anat] 382:227–235
Otto HF, Siemssen S, Sill V (1972) Zur Differentialdiagnose von M. Whipple und Sarkoidose. Dtsch Med Wochenschr 97:1343–1347
Rodarte JP, Garrison CO, Holley CE, Fontana RS (1972) Whipple's disease simulating sarcoidosis. Arch Intern Med 129:479–482
Pequignot H, Morin Y, Grandjouan S, Guerre J, Liot F, Deslignières S, Duflo B (1972) Sarcoïdose et maladie de Whipple. Ann Med Interne (Paris) 11:479–482
Mueller M, Schlotterhoss I (1966) Erzeugung für den M. Whipple typischer lokaler Gewebsveränderungen bei Mäusen durch formalinfixiertes SPC-zellhaltiges menschliches Material. Zentralbl Allg Pathol 109:46–51
Barbaryka I, Thorn L, Langer E (1978) Granulome der Dünndarmschleimhaut beim M. Whipple. Verh Dtsch Ges Pathol 62:527
Cohen ML, Payne TP (1966) Whipple's disease. NY State J Med 66:2148–2154
Kraunz RF (1969) Whipple's disease with cardiac and renal abnormalities. Arch Intern Med 123:701–706
Ammann RW (1957) Zur Differentialdiagnose, Pathogenese und Ätiologie des M. Whipple. Helv Med Acta 2:118 143
Favez G (1971) Circulating antibodies directed against Kveim antigen and a human normal spleen extract in sarcoidosis. Am Rev Respir Dis 104:599–601
Liebermann F (1976) The specifity and nature of serum angiotensin converting enzyme (serum ACE) elevations in sarcoidosis. Ann NY Acad Sci 278:488–496
Maxwell JD, Ferguson A, McKay A, Imrie RC, Watson WC (1968) Lymphocytes in Whipple's disease. Lancet I:887–889
Feurle GE, Dorken B, Schopf E, Lenhard V (1979) HLA B27 and defects in the T-cell system in Whipple's disease. Eur J Clin Invest 5 (Oct 9):385–389
Haeney MR, Ross IN (1978) Whipple's disease in female with impaired cell mediated immunity unresponsive to cotrimoxazole and levamisol therapy. Postgrad Med J 54/627:45–50
Tygat GN, Hoogendijk JL, Agenant D, Schellekens PT (1977) Etiopathogenetic studies in a patient with Whipple's disease. Digestion 15/4:309–321
Clancy MR, Muckle TJ, De Jesus D, Stevens D (1977) Characteristics of the immune response in a patient with Whipple's disease. Aust NZ J Med 7/3:294–298
Clancy RL, Tomkins WAF, Muckle TJ, Richardson H, Rawls WE (1975) Isolation and characterization of an Ätiological agent in Whipple's disease. Br Med J 3:568–570
Charache P, Bayless TM, Shelley WM, Hendrix TR (1966) Atypical bacteria in Whipple's disease. Trans Assoc Am Physicians 79:399–408
Editorial (1977) Correcting the calcium. Br Med J 1:598
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Schlumpf, A., Marbet, U.A., Stöcklin, E. et al. Chronic interstitial nephritis in Whipple's disease. Klin Wochenschr 61, 25–33 (1983). https://doi.org/10.1007/BF01484436
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF01484436