Whipple's arthritis: direct detection of Tropheryma whippelii in synovial fluid and tissue.
We describe 2 patients presenting with polyarthritis in whom the synovial fluid (1 patient) or synovial tissue (1 patient) was positive for Tropheryma whippelii, the Whipple's disease-associated bacillus, when examined by polymerase chain reaction (PCR) and DNA sequencing. Histopathologic findings were consistent with articular Whipple's disease in the synovial fluid of 1 patient and the synovial tissue of the other. In both patients, bowel mucosal specimens were negative for Whipple's disease features by histologic and PCR methods. One patient was positive for T whippelii in the peripheral blood. Control synovial fluid specimens from 40 patients with other arthritides, including Lyme arthritis, were negative. Sequencing of a 284-basepair region of the 16S ribosomal RNA gene confirmed that the sequence is closely related to the known T whippelii sequence. Both patients responded to treatment with antibiotics.
O'Duffy
J D
JD
Mayo Clinic, Rochester, Minnesota 55905, USA.
Griffing
W L
WL
Li
C Y
CY
Abdelmalek
M F
MF
Persing
D H
DH
D039903:Actinobacteria / Q000235:genetics / Q000302:isolation & purification; D000328:Adult; D016918:Arthritis, Reactive / Q000382:microbiology*; D004269:DNA, Bacterial / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012329:RNA, Bacterial / Q000032:analysis; D012336:RNA, Ribosomal, 16S / Q000032:analysis; D013582:Synovial Fluid / Q000382:microbiology*; D013583:Synovial Membrane / Q000382:microbiology*; D008061:Whipple Disease / Q000150:complications* / Q000175:diagnosis*
D004269:DNA, Bacterial; D012329:RNA, Bacterial; D012336:RNA, Ribosomal, 16S