title: Short article: Relapsing Whipple's disease: a case report and literature review.
abstract: Whipple's disease is a rare infection caused by Tropheryma whipplei, a Gram-negative Bacillus usually found in macrophages of the lamina propria of the small intestine. The typical clinical manifestations of classic Whipple's disease are diarrhea, weight loss, malabsorption, abdominal pain, and arthralgia. The disease's laboratory diagnosis is currently based on duodenal biopsy. Treatment generally includes primary therapy for 2 weeks with intravenous antibiotics capable of reaching high levels in the cerebrospinal fluid, such as ceftriaxone, usually followed by treatment with oral cotrimoxazole for 1 year. Early diagnosis should enable appropriate treatment and improves the prognosis, and prolonged antibiotic treatment often leads to complete remission. Our case report focuses on a 72-year-old man who had been passing watery stools for 1-2 months, accompanied by low-grade fever. He reported profound asthenia, a weight loss of about 3 kg, and loss of appetite. Thirty years earlier (in 1984), he had been working as a horse keeper at a University Department of Agricultural and Veterinary Studies, where he had contracted Whipple's disease. Laboratory tests and microbiological studies led to a diagnosis of recurrent Whipple's disease. Esophagogastroduodenoscopy was performed under deep sedation. Biopsy samples obtained from the stomach and duodenum were stained with hematoxylin and eosin, Giemsa, and periodic acid-Schiff to identify any accumulation of typical periodic acid-Schiff-positive macrophages in the lamina propria. A specific quantitative real-time PCR assay using specific oligonucleotide probes for targeting repeated sequences of Tropheryma whipplei was also performed to detect its DNA in the duodenum samples.
authors.affiliation: Departments of aMedicine, Geriatric Division bMedicine cSurgical and Gastroenterological Sciences, University of Padova, Padova, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Ruggiero
authors.forename: Anna
authors.initials: A
authors.lastname: Zurlo
authors.forename: Valter
authors.initials: V
authors.lastname: Giantin
authors.forename: Francesca
authors.initials: F
authors.lastname: Galeazzi
authors.forename: Claudia
authors.initials: C
authors.lastname: Mescoli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Nante
authors.forename: Florinda
authors.initials: F
authors.lastname: Petruzzellis
authors.forename: Enzo
authors.initials: E
authors.lastname: Manzato
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001431:Bacteriological Techniques; D001706:Biopsy; D004269:DNA, Bacterial / Q000235:genetics; D004334:Drug Administration Schedule; D004386:Duodenum / Q000382:microbiology* / Q000473:pathology; D016145:Endoscopy, Digestive System; D006801:Humans; D008297:Male; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D012008:Recurrence; D013270:Stomach / Q000382:microbiology / Q000473:pathology; D016896:Treatment Outcome; D054851:Tropheryma / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D008061:Whipple Disease / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial