An atypical case of Whipple's disease: case report and review of the literature.
We report the case of a 57-year-old man, presenting with bilateral panuveitis, bilateral sacroiliitis, intermittent pyrexia and a pulmonary nodule. The patient had been under immunosuppressive treatment for 2 years for Behçet's disease. However, he did not fulfill the diagnostic criteria of Behçet's disease. Blood analysis showed a very high C reactive protein (CRP at 34 mg/dl). In view of severe intra-ocular inflammation, the anterior chamber was punctured. Polymerase chain reaction (PCR) on the aqueous humour and on the blood revealed the presence of Tropheryma whippelii DNA, an agent responsible for Whipple's disease. The patient was treated with ceftriaxone followed by trimethoprim-sulfamethoxazol for 1 year with good clinical and biological evolution. This case illustrates the difficulty to diagnose an atypical Whipple's disease. In cases of uveitis with atypical signs and/or not responding to the treatment, the internist must consider to perform an analysis of the ocular fluids.
Department of General Internal Medicine, Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium. Isabelle.Nubourgh@ulb.ac.be
I
I
Nubourgh
F
F
Vandergheynst
P
P
Lefebvre
A
A
Lemy
N
N
Dumarey
G
G
Decaux
D001082:Aqueous Humor / Q000382:microbiology; D001706:Biopsy; D002097:C-Reactive Protein / Q000378:metabolism; D004269:DNA, Bacterial / Q000032:analysis; D003937:Diagnosis, Differential; D004386:Duodenum / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D054851:Tropheryma / Q000235:genetics / Q000302:isolation & purification; D008061:Whipple Disease / Q000175:diagnosis* / Q000378:metabolism
D004269:DNA, Bacterial; D002097:C-Reactive Protein