Tropheryma whipplei infection (Whipple's disease) in a patient after liver transplantation.
Whipple's disease (WD) is a rare infection caused by the bacterium Tropheryma whipplei that can affect multiple organs and most commonly occurs in the immunocompetent host. Only 3 cases of WD have been reported in the setting of immunosuppression for organ transplantation. Here, we report the first case of WD, to our knowledge, in a patient after liver transplantation with comorbid graft-versus-host-disease. We discuss the diagnostic challenges in this setting and the value of electron microscopy and in situ hybridization methods for confirming the infection. WD may be under-diagnosed in immunosuppressed transplant patients because the disease can present with atypical clinical and histological features that suggest other conditions.
Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington, USA.
S M
SM
Vindigni
Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington, USA.
J
J
Taylor
Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA.
L A S
LA
Quilter
Department of Pathology, University of Washington, Seattle, Washington, USA.|Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
T S
TS
Hyun
Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
C
C
Liu
Seattle Cancer Care Alliance, Seattle, Washington, USA.
S L
SL
Rosinski
Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA.
R M
RM
Rakita
Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
D N
DN
Fredricks
Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington, USA.|Gastroenterology/Hepatology Section, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
C J
CJ
Damman
D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D003967:Diarrhea / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D016099:Endoscopy, Gastrointestinal; D017809:Fatal Outcome; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects* / Q000379:methods; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D017404:In Situ Hybridization, Fluorescence; D007413:Intestinal Mucosa / Q000473:pathology; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008854:Microscopy, Electron; D010198:Pancytopenia / Q000097:blood / Q000209:etiology; D054851:Tropheryma / Q000302:isolation & purification* / Q000648:ultrastructure; D008061:Whipple Disease / Q000097:blood / Q000188:drug therapy / Q000382:microbiology*
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents
Tropheryma whipplei; Whipple's disease; gastroenterology; graft-versus-host disease; hepatology; immunosuppression; liver transplantation