Renal amyloidosis in Whipple disease: a case report.
BACKGROUND
Whipple disease is a rare systemic infection caused by Tropheryma whippelii that usually manifests with joint pain, weight loss, diarrhoea and abdominal pain. However, in some cases the infection may involve other organs and tissues.


METHODS
We report on a 44-year-old man with Whipple disease which led to renal amyloidosis and end-stage renal failure. In this case, the patient was diagnosed with Whipple disease and commenced on a 12-month trimetoprime-sulfametoxasole therapy with good result. Six months after cessation of therapy the patient was readmitted to hospital due to signs of renal failure. An urgent kidney biopsy was performed which revealed secondary amyloidosis. Despite intensive immunosuppressive treatment, renal parameters gradually deteriorated and haemodialysis was started eventually. Three months later the patient's general condition dramatically worsened with bloody diarrhoea, bilious vomiting and progressive malnutrition. The repeated endoscopic examination confirmed severe recurrence of Whipple disease. Ceftriaxone and total parenteral nutrition was started what greatly improved patient's state.


CONCLUSIONS
To our knowledge based on systematic review, this is the first case report on Whipple disease complicated by secondary amyloidosis and kidney failure maintained on permanent renal replacement therapy. It is strongly suspected that the use of immunosuppressive treatment in such cases may exacerbate the course of Whipple disease and cause life-threatening complications.
Niemczyk
Stanislaw
S
Department of Nephrology, Dialysis Therapy and Internal Medicine, Medical University of Warsaw, 1a Banacha Street, 02-097 Warsaw, Poland. sniemczyk@wum.edu.pl
Filipowicz
Ewa
E
Wozniacki
Lukasz
L
Grochowski
Janusz
J
Zaleski
Leszek
L
Grzejszczak
Agnieszka
A
Ptasinska
Agnieszka Perkowska
AP
Koperski
Lukasz
L
Rowinska
Joanna Matuszkiewicz
JM