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Whipple's disease - a rare and challenging complication in a patient with Crohn's disease

Kerem Bulut1, Antoaneta Markova2, Ali E Canbay3

  • 1Clinic for Internal Medicine and Gastroenterology, St. Clemens-Hospital Geldern, Germany.

Zeitschrift Fur Gastroenterologie
|February 17, 2022
PubMed
Abstract

Insights

Whipple's disease (WD), caused by Tropheryma whipplei, mimics Crohn's disease symptoms. Early diagnosis via endoscopy and biopsy is crucial to prevent fatal misdiagnosis and inappropriate immunosuppression in IBD patients.

Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Microbiology

Background:

  • Whipple's disease (WD) is a rare infectious condition caused by Tropheryma whipplei (TW), leading to multi-organ impairment.
  • TW is detectable via PAS-positive macrophages and PCR in tissues.
  • WD symptoms like diarrhea, abdominal pain, and weight loss overlap with Crohn's disease (CD) flares, risking misdiagnosis.

Observation:

  • A young male patient with pre-existing CD presented with symptoms mimicking a CD flare.
  • Intensified immunosuppressive therapy for presumed CD led to refractory diarrhea and opportunistic infections.
  • The patient experienced a fatal outcome due to misdiagnosis and delayed/inappropriate treatment.

Findings:

  • The case highlights the diagnostic challenge posed by WD in patients with inflammatory bowel disease (IBD).
  • Misinterpreting WD as a CD flare can lead to escalating immunosuppression, worsening the infection.
  • Timely and accurate diagnosis of WD is critical, especially before increasing immunosuppressive therapy.

Implications:

  • Patients with IBD are susceptible to various infections, including WD, beyond C. difficile and CMV.
  • Endoscopy with biopsy for WD detection is recommended before escalating immunosuppressive treatment in IBD patients.
  • Ruling out WD is essential to prevent fatal outcomes in IBD patients presenting with overlapping symptoms.

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