Multisegmental spondylitis due to Tropheryma whipplei: case report.
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.
Spoerl
David
D
Department of Rheumatology, University of Basel, Felix Platter Spital, Basel, Switzerland. spoerld@uhbs.ch
Bär
Diego
D
Cooper
Julian
J
Vogt
Thomas
T
Tyndall
Alan
A
Walker
Ulrich A
UA
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*