title: Nearly Fatal Case of Whipple's Disease in a Patient Mistakenly on Anti-TNF Therapy.
abstract: Whipple's disease is a rare cause of chronic diarrhea and abdominal pain that may be confused with inflammatory bowel disease. We report a Whipple's case misdiagnosed as Crohn's disease in which treatment with anti-tumor necrosis factor (anti-TNF) therapy led to nearly fatal progression. Lymph node tissue obtained during laparotomy for suspected bowel necrosis stained dramatically with periodic acid-Schiff (PAS), and electron microscopy showed a bacterium consistent with Trophyrema whipplei. The patient made a remarkable recovery complicated only by cholestatic hepatitis, which was likely a treatment-associated inflammatory response. This case serves as a reminder that all granulomatous infections should be considered prior to initiation of anti-TNF therapies.
authors.affiliation: Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Christen
authors.initials: C
authors.lastname: Klochan
authors.affiliation: Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Teresa A
authors.initials: TA
authors.lastname: Anderson
authors.affiliation: Purdue University School of Pharmacy, Indianapolis, IN.
authors.forename: Dusten
authors.initials: D
authors.lastname: Rose
authors.affiliation: Department of Pathology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Rosen K
authors.initials: RK
authors.lastname: Dimitrov
authors.affiliation: Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Raymond M
authors.initials: RM
authors.lastname: Johnson