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[Diagnostic issues of Whipple's disease during chronic inflammatory rheumatism: About three cases]

D Delarbre1, L Gan2, C Antoine1

  • 1Service de médecine interne, Hôpital d'instruction des armées Sainte-Anne, 1, boulevard Sainte Anne, 83000 Toulon, France.

La Revue De Medecine Interne
|July 5, 2021
PubMed
Abstract

Insights

Diagnosing Whipple's disease (WD) is challenging when it mimics inflammatory rheumatism, especially under anti-tumor necrosis factor inhibitor (TNFI) therapy. Consider testing for Tropheryma whipplei in refractory cases.

Area of Science:

  • Rheumatology
  • Infectious Diseases
  • Microbiology

Background:

  • Whipple's disease (WD) can present as chronic inflammatory rheumatism, leading to inappropriate use of tumor necrosis factor inhibitors (TNFI).
  • TNFI treatment may alter the host-pathogen relationship in Tropheryma whipplei infections.
  • High rates of asymptomatic Tropheryma whipplei carriage complicate WD diagnosis in patients with unexplained arthritis.

Purpose of the Study:

  • To highlight the diagnostic value of Tropheryma whipplei detection in specific clinical scenarios.
  • To guide the differential diagnosis of inflammatory rheumatism, particularly in patients on TNFI therapy.

Main Methods:

  • Case report series illustrating the utility of Tropheryma whipplei detection.
  • Analysis of clinical presentations mimicking inflammatory rheumatism.

Main Results:

  • Three cases demonstrating the importance of Tropheryma whipplei identification in differential diagnosis.
  • The study underscores the challenge of diagnosing WD amidst inflammatory conditions.

Conclusions:

  • Testing for Tropheryma whipplei should be based on individual clinical assessment.
  • Consider T. whipplei testing for inflammatory rheumatism unresponsive or worsening under TNFI treatment, especially with atypical features.
  • Systematic pre-treatment screening for T. whipplei before anti-TNF therapy is not recommended due to frequent asymptomatic carriage.
Keywords:
Anti-TNFArthritisDMARDsMaladie de WhipplePolyarthriteTropheryma whippleiTumor necrosis factor inhibitorsWhipple's disease

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