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Arthritis in Whipple's disease.
Israel Journal of Medical Sciences
|June 1, 1981
Summary
Whipple's disease can affect joints years before gut symptoms appear. Synovial membrane biopsy is crucial for diagnosing this rare infection when joint inflammation is present.
Area of Science:
- Rheumatology
- Infectious Diseases
- Histopathology
Background:
- Whipple's disease is a rare systemic bacterial infection primarily affecting the gastrointestinal tract.
- Musculoskeletal manifestations, particularly polyarthritis, can precede gastrointestinal symptoms by many years, complicating early diagnosis.
Observation:
- Synovial fluid analysis in one patient showed a high white blood cell count (28,350/mm3) with 96% neutrophils.
- Synovial membrane biopsy revealed neutrophilic infiltrate, periodic acid-Schiff positive macrophages, and characteristic bacilliform structures.
Findings:
- The study identified key histopathological markers in synovial tissue indicative of Whipple's disease.
- Nonspecific inflammation was observed in synovial fluid and membranes during intercritical periods or in less advanced cases.
Implications:
- Early diagnosis of Whipple's disease is possible through synovial membrane biopsy, even in the absence of gastrointestinal symptoms.
- This diagnostic approach is vital for patients presenting with unexplained polyarthritis and systemic signs suggestive of Whipple's disease.