Spondylodiscitis revealing Whipple disease

Area of Science:

• Infectious Diseases
• Rheumatology
• Microbiology

Background:

• Whipple disease is a rare chronic infection caused by Tropheryma whipplei.
• Classic symptoms include digestive issues and polyarthralgia; diagnosis typically involves duodenal biopsies and PCR.
• Localized infections can delay diagnosis, and bone involvement is exceptionally rare.

Purpose of the Study:

• To report an unusual case of Whipple disease presenting as subacute spondylodiscitis.
• To emphasize the diagnostic utility of PCR on affected tissue in atypical presentations.
• To highlight effective treatment for this rare manifestation.

Main Methods:

• Case presentation of an 82-year-old patient with seronegative rheumatoid arthritis.
• Magnetic resonance imaging (MRI) for assessing spondylodiscitis.
• Polymerase chain reaction (PCR) testing on disco-vertebral biopsies and duodenal biopsies.

Main Results:

• The patient presented with subacute spondylodiscitis, diagnosed via MRI.
• PCR confirmed Tropheryma whipplei in disco-vertebral biopsies; duodenal biopsies were negative.
• Symptoms significantly improved with doxycycline and hydroxychloroquine treatment.

Conclusions:

• Whipple disease can present atypically with bone and joint involvement, such as spondylodiscitis.
• PCR testing on affected tissue is crucial for diagnosing localized Tropheryma whipplei infections.
• Prompt antibiotic treatment led to rapid symptom improvement.