Abstract
The clinical features of Whipple’s disease (WD) consist of arthropathy that precedes the involvement of other organs, such as the gastrointestinal tract, nervous system and heart. It has been shown that gastrointestinal manifestations can be precipitated by immunosuppressive therapy used to control the arthropathy. In the present study, we investigated the clinical features of the Italian population of patients affected by WD. The clinical histories of 22 patients with WD were reviewed. Relationship between previous treatments and onset of symptoms was analysed. 20/22 patients suffered from arthropathy that had started before gastrointestinal complaints; gastrointestinal symptoms were present in 18 patients and neurological involvement was found in 5. WD must always be taken into account in male patients with long-standing ill-defined arthropathy, and it should be ruled out before starting immunosuppressive or antibiotic treatment that can make correct diagnosis and management very difficult.
Similar content being viewed by others
References
Fennolar F, Puechal X, Raoult D (2007) Whipple’s disease. N Engl J Med 356:55–66
Schneider T, Moos V, Loddenkemper C, Marth T, Fenollar F, Raoult D (2008) Whipple’s disease: new aspects of pathogenesis and treatment. Lancet Infect Dis 8:179–190
Relman DA, Schmidt TM, MacDermott RP, Falkow S (1992) Identification of the uncultured bacillus of Whipple’s disease. N Engl J Med 327:293–301
Raoult D, Birg ML, La Scola B, Fournier PE, Enea M, Lepidi H, Roux V, Piette JC, Vandenesch F, Vital-Durand D, Marrie TJ (2000) Cultivation of the bacillus of Whipple’s disease. N Engl J Med 342:620–625
Schöniger-Hekele M, Petermann D, Weber B, Müller C (2007) Tropheryma whipplei in the environment: survey of sewage plant influxes and sewage plant workers. Appl Environ Microbiol 73:2033–2035
Lagier JC, Fenollar F, Lepidi H, Raoult D (2011) Evidence of lifetime susceptibility to Tropheryma whipplei in patients with Whipple’s disease. J Antimicrob Chemother 66:1188–1189
Li W, Fennolar F, Rolain J-M, Fournier P-E, Feurle GE, Müller C, Moos V, Marth T, Altwegg M, Calligaris-Maibach RC, Schneider T, Biagi F, La Scola B, Raoult D (2008) Genotyping reveals a wide heterogeneity of Tropheryma whipplei. Microbiology 154:521–527
Martinetti M, Biagi F, Badulli C, Feurle GE, Müller C, Moos V, Schneider T, Marth T, Marchese A, Trotta L, Sachetto S, Pasi A, De Silvestri A, Salvaneschi L, Corazza GR (2009) The HLA alleles DRB1*13 and DQB1*06 are associated to Whipple’s disease. Gastroenterology 136:2289–2294
Marth T, Kleen N, Stallmach A, Ring S, Aziz S, Schmidt C, Strober W, Zeitz M, Schneider T (2002) Dysregulated peripheral and mucosal Th1/Th2 response in Whipple’s disease. Gastroenterology 123:1468–1477
Fennolar F, Raoult D (2001) Whipple’s disease. Clin Diagn Lab Immunol 8:1–8
Dutly F, Altwegg M (2001) Whipple’s disease and “Tropheryma whippelii”. Clin Microbiol Rev 14:561–583
Di Stefano M, Jorizzo RA, Brusco G, Cecchetti L, Sciarra G, Loperfido S, Brandi G, Gasbarrini G, Corazza GR (1998) Bone mass and metabolism in Whipple’s disease: the role of hypogonadism. Scand J Gastroenterol 33:1180–1185
Raoult D, La Scola B, Lecocq P, Lepidi H, Fournier PE (2001) Culture and immunological detection of Tropheryma whippelii from the duodenum of a patient with Whipple disease. JAMA 285:1039–1043
Feurle GE, Junga NS, Marth T (2010) Efficacy of ceftriaxone or meropenem as initial therapies in Whipple’s disease. Gastroenterology 138:478–486
Lagier JC, Fenollar F, Lepidi H, Raoult D (2011) Evidence of lifetime susceptibility to Tropheryma whipplei in patients with Whipple’s disease. J Antimicrob Chemother 66:1188–1189
Mahnel R, Kalt A, Ring S, Stallmach A, Strober W, Marth T (2005) Immunosuppressive therapy in Whipple’s disease patients is associated with the appearance of gastrointestinal manifestations. Am J Gastroenterol 100:1167–1173
Feurle GE, Moos V, Schinnerling K, Geelhaar A, Allers K, Biagi F, Bläker H, Moter A, Loddenkemper C, Jansen A, Schneider T (2010) The immune reconstitution inflammatory syndrome in Whipple disease. A cohort study. Ann Intern Med 153:710–717
Lamparter S, Dittrich C, Koehler HH (2008) Exacerbation of WD by immunosuppressants. J Clin Gastroenterol 42:760–761
Kneitz C, Suerbaum S, Beer M, Müller J, Jahns R, Tony HP (2005) Exacerbation of Whipple’s disease associated with infliximab treatment. Scand J Rheumatol 34:148–151
Hoppè E, Masson C, Audran M, Drillon M, Andreu M, Saraux A, Berthelot JM, Maugars Y, Hmamouchi I, Morel J (2010) Whipple’s disease diagnosed during biological treatment for joint disease. Joint Bone Spine 77:335–339
Corazza GR, Brusco G, Andreani ML, Biagi F, Di Stefano M, Gasbarrini G (1996) Previous misdiagnosis and diagnostic delay in adult celiac sprue. J Clin Gastroenterol 22:324–325
Acknowledgments
We are grateful to Susan West for reading and correcting the manuscript. This project was funded by the 5th Framework Programme of the European Commission (ref. QLG1-CT-2002-01049).
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Trotta, L., Biagi, F., Di Stefano, M. et al. Relationship between previous treatments and onset of symptoms in patients with Whipple’s disease. Intern Emerg Med 9, 161–164 (2014). https://doi.org/10.1007/s11739-012-0799-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11739-012-0799-4