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Whipple's disease: case report and review of the literature

Vincenzo De Francesco1, Fabrizio Corsi2, Antonio Pennella2

  • 1Section of Gastroenterology, Department of Medical Sciences, Foggia, Italy.vdefrancesco@ospedaliriunitifoggia.it.

Journal of Gastrointestinal and Liver Diseases : JGLD
|September 22, 2018
PubMed

Insights

Whipple's disease (WD), a chronic infection by Tropherima whipplei, often presents with rheumatic symptoms before intestinal issues arise. Steroid treatment can unmask or worsen these gastrointestinal manifestations, highlighting diagnostic challenges.

Area of Science:

  • Infectious Diseases
  • Gastroenterology
  • Rheumatology

Background:

  • Whipple's disease (WD) is a rare systemic infection caused by Tropherima whipplei.
  • It often features a prolonged prodromal phase and diverse extra-intestinal symptoms, leading to diagnostic delays and misdiagnosis.
  • Rheumatic manifestations can precede overt gastrointestinal symptoms, complicating early identification.

Observation:

  • A 62-year-old man received a histological diagnosis of WD after initiating oral steroid therapy for rheumatic symptoms.
  • The steroid treatment precipitated gastrointestinal symptoms, leading to the WD diagnosis.
  • A systematic literature review identified three patient subgroups based on clinical presentation.

Findings:

  • The case illustrates a specific trigger for WD symptom manifestation.
  • Literature review supports the heterogeneity of WD clinical presentations.
  • Duodenal biopsies are crucial for diagnosing WD, even with initial non-gastrointestinal complaints.

Implications:

  • Early recognition of WD's protean manifestations is critical for timely and accurate diagnosis.
  • Understanding triggers like immunosuppression may aid in earlier WD detection.
  • Further research into WD subgroups can refine diagnostic and treatment strategies.

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