title: Hypertrophic osteoarthropathy can indicate recurrence of Whipple's disease.
abstract: We report the case of a patient with Whipple's disease (WD) who developed hypertrophic osteoarthropathy (HOA) characterized by digital clubbing, periostosis of the tubular bones, and polysynovitis. The HOA disclosed the recurrence of the patient's WD, since polymerase chain reaction (PCR) analysis clearly demonstrated the presence of Tropheryma whippelii in the synovial fluid from the patient's left knee. Initiation of appropriate antibiotic therapy resulted in complete healing of all clinical rheumatologic manifestations within 2 months and in disappearance of radiographic bone changes at 7-month followup. We suggest that HOA be included within the spectrum of rheumatologic manifestations of WD, and that an evaluation for WD should be considered in patients, especially middle-aged men, presenting with HOA even without gastrointestinal symptoms. PCR analysis may be useful in accurate diagnosis and management of early WD with unusual clinical manifestations, and may contribute to decreased morbidity and mortality.
authors.affiliation: Centre Hospitalier Universitaire de Rouen-Boisguillaume, Rouen, France.
authors.forename: I
authors.initials: I
authors.lastname: Marie
authors.forename: H
authors.initials: H
authors.lastname: Levesque
authors.forename: M H
authors.initials: MH
authors.lastname: Levade
authors.forename: N
authors.initials: N
authors.lastname: Cailleux
authors.forename: F
authors.initials: F
authors.lastname: Lecomte
authors.forename: A
authors.initials: A
authors.lastname: François
authors.forename: J
authors.initials: J
authors.lastname: Métayer
authors.forename: E
authors.initials: E
authors.lastname: Lerebours
authors.forename: H
authors.initials: H
authors.lastname: Courtois
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001706:Biopsy; D001842:Bone and Bones / Q000000981:diagnostic imaging; D004386:Duodenum / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010004:Osteoarthropathy, Primary Hypertrophic / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D011859:Radiography; D008061:Whipple Disease / Q000150:complications* / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents