title: [Whipple's disease associated with opportunistic infections].
abstract: A 36-year-old man, with a history of recurrent respiratory infection, dermatomycosis, arthralgia and abnormal stools for 12 years, developed a febrile illness (up to 40 degrees C). A Serratia marcescens septicaemia responded to antibiotics. Four months later cervical and abdominal lymph-adenopathies were noticed. Cervical lymph node biopsy revealed lymphadenitis with epithelioid cell nests. Duodenoscopy with biopsy demonstrated Whipple's disease associated with lambliasis. Electron-microscopy showed rod-shaped bacteria typical of Whipple's disease, and Giardia lamblia. Using the polymerase chain reaction, Whipple-specific DNA fragments of 284 base pairs from the genome of the Whipple bacterium (Tropheryma whippelii) were demonstrated. Antibiotic treatment with Ampicillin (2 g three times daily) and ceftriaxone (2 g once daily) i.v. for 21 days, followed by oral ofloxacin (200 mg daily) and co-trimoxazole (three times daily 800 mg sulfamethoxazole and 160 mg trimethoprim), brought about remission of Whipple's disease. Long-term antibiotic treatment was continued with co-trimoxazole. Lambliasis recurred after 3 and 5 months, despite treatment with metronidazole, 250 mg three times daily for 7 days.
authors.affiliation: Abteilung Innere Medizin V, Medizinische Klinik und Poliklinik, Universität Heidelberg.
authors.forename: H J
authors.initials: HJ
authors.lastname: Meier-Willersen
authors.forename: M
authors.initials: M
authors.lastname: Maiwald
authors.forename: A
authors.initials: A
authors.lastname: von Herbay
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents; D001706:Biopsy; D003881:Dermatomycoses / Q000150:complications / Q000188:drug therapy; D003952:Diagnostic Imaging; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D004384:Duodenoscopy; D006801:Humans; D008297:Male; D008828:Microbiological Techniques; D009894:Opportunistic Infections / Q000150:complications* / Q000188:drug therapy; D016133:Polymerase Chain Reaction; D012141:Respiratory Tract Infections / Q000150:complications / Q000188:drug therapy; D008061:Whipple Disease / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents