Resolution of whipple disease-induced pulmonary hypertension following antibiotic therapy.
Whipple disease is a disorder caused by Tropheryma whipplei, a ubiquitous Gram-positive bacillus. In addition to gastrointestinal manifestations, many other systems may be involved in Whipple disease. Pulmonary hypertension (PH) is a rare manifestation of Whipple disease, and its clinical course is not well established. We report a case of a 45-year-old woman who presented with typical gastrointestinal manifestations of Whipple disease, which was diagnosed by duodenal biopsy. She was also noted to have elevated pulmonary arterial pressures on transthoracic echocardiography. There was no evidence of left-sided valvular disease, hypertrophy, or dyskinesis, and there was no evidence of endocarditis. The patient was started on intravenous ceftriaxone for 6 weeks and then transitioned to oral trimethoprim-sulfamethoxazole for a year. The patient demonstrated clinical improvement, endoscopic and histologic improvement, and also resolution of PH. This is the third reported case of PH that is convincingly secondary to Whipple disease that resolved after appropriate antibiotic therapy.
1Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY; 2Department of Medicine, Division of Infectious Diseases, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY; 3Department of Medicine, Division of Gastroenterology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY; and 4Department of Pathology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY.
Sumedh S
SS
Hoskote
Anca
A
Georgescu
Lisa
L
Ganjhu
Nebras
N
Zeizafoun
Bruce
B
Polsky
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology*; D008875:Middle Aged; D008061:Whipple Disease / Q000150:complications* / Q000188:drug therapy*
D000900:Anti-Bacterial Agents