title: Multisegmental spondylitis due to Tropheryma whipplei: case report.
abstract: We report a patient who presented with inflammatory back pain due to multisegmental spondylitis. Following a vertebral biopsy which failed to detect an infectious organism, the patient was treated with etanercept, a tumor necrosis factor (TNF)-alpha inhibitor, for suspected undifferentiated spondyloarthritis. The back pain worsened and the spondylitic lesions increased. Only in a vertebral rebiopsy with polymerase chain reaction (PCR) amplification of Tropheryma whipplei, the causative agent of Whipple's disease was identified. Tropheryma whipplei should be considered as a cause of spondylitis even with multisegmental involvement and in the absence of gastrointestinal symptoms. In this clinical setting, routine PCR for Tropheryma whipplei from vertebral biopsies is recommended.
authors.affiliation: Department of Rheumatology, University of Basel, Felix Platter Spital, Basel, Switzerland. spoerld@uhbs.ch
authors.forename: David
authors.initials: D
authors.lastname: Spoerl
authors.forename: Diego
authors.initials: D
authors.lastname: Bär
authors.forename: Julian
authors.initials: J
authors.lastname: Cooper
authors.forename: Thomas
authors.initials: T
authors.lastname: Vogt
authors.forename: Alan
authors.initials: A
authors.lastname: Tyndall
authors.forename: Ulrich A
authors.initials: UA
authors.lastname: Walker
mesh_terms: D006801:Humans; D008159:Lumbar Vertebrae / Q000382:microbiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods; D013166:Spondylitis / Q000382:microbiology* / Q000473:pathology; D054851:Tropheryma / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D008061:Whipple Disease / Q000382:microbiology*