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Whipple's Disease (WD) Without Arthropathy in an Immunocompromised Patient

Whipple’s disease (WD) is a rare disorder caused by the pathogen Tropheryma whipplei (T. whipplei). We report a unique presentation of WD in which the patient did not exhibit arthralgia which is characteristic of this disease. A 67-year-old man with a history of chronic hepatitis B infection and hum...

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Autores principales: Khrais, Ayham, Han, Bing, Ramasamy, Dhanasekaran, Kumar, Shiva
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9761016/
https://www.ncbi.nlm.nih.gov/pubmed/36545168
http://dx.doi.org/10.7759/cureus.31659
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author Khrais, Ayham
Han, Bing
Ramasamy, Dhanasekaran
Kumar, Shiva
author_facet Khrais, Ayham
Han, Bing
Ramasamy, Dhanasekaran
Kumar, Shiva
author_sort Khrais, Ayham
collection PubMed
description Whipple’s disease (WD) is a rare disorder caused by the pathogen Tropheryma whipplei (T. whipplei). We report a unique presentation of WD in which the patient did not exhibit arthralgia which is characteristic of this disease. A 67-year-old man with a history of chronic hepatitis B infection and human immunodeficiency virus (HIV) infection presented with weight loss, nausea, vomiting, and myalgia. Endoscopy demonstrated erythema in the gastric body, lymphangiectasia of the duodenum, and increased granularity of the terminal ileum. Mucosal biopsies revealed macrophages in the lamina propria with focal histiocytic aggregates throughout the small bowel and cecum, consistent with WD. Confirmatory T. whipplei polymerase chain reaction(PCR) testing was positive. WD is a rare diagnosis that must be considered in the differential diagnoses of patients presenting with unexplained nausea, vomiting, diarrhea, and anemia. Furthermore, in patients with HIV, the possibilities would also include opportunistic gastrointestinal pathogens. Classic WD is characterized by diarrhea, weight loss, abdominal pain, and extra-intestinal involvement manifesting as joint pain. We describe a case of WD occurring in a patient with HIV, without the disease's characteristic joint involvement. 
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spelling pubmed-97610162022-12-20 Whipple's Disease (WD) Without Arthropathy in an Immunocompromised Patient Khrais, Ayham Han, Bing Ramasamy, Dhanasekaran Kumar, Shiva Cureus Internal Medicine Whipple’s disease (WD) is a rare disorder caused by the pathogen Tropheryma whipplei (T. whipplei). We report a unique presentation of WD in which the patient did not exhibit arthralgia which is characteristic of this disease. A 67-year-old man with a history of chronic hepatitis B infection and human immunodeficiency virus (HIV) infection presented with weight loss, nausea, vomiting, and myalgia. Endoscopy demonstrated erythema in the gastric body, lymphangiectasia of the duodenum, and increased granularity of the terminal ileum. Mucosal biopsies revealed macrophages in the lamina propria with focal histiocytic aggregates throughout the small bowel and cecum, consistent with WD. Confirmatory T. whipplei polymerase chain reaction(PCR) testing was positive. WD is a rare diagnosis that must be considered in the differential diagnoses of patients presenting with unexplained nausea, vomiting, diarrhea, and anemia. Furthermore, in patients with HIV, the possibilities would also include opportunistic gastrointestinal pathogens. Classic WD is characterized by diarrhea, weight loss, abdominal pain, and extra-intestinal involvement manifesting as joint pain. We describe a case of WD occurring in a patient with HIV, without the disease's characteristic joint involvement.  Cureus 2022-11-18 /pmc/articles/PMC9761016/ /pubmed/36545168 http://dx.doi.org/10.7759/cureus.31659 Text en Copyright © 2022, Khrais et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Internal Medicine
Khrais, Ayham
Han, Bing
Ramasamy, Dhanasekaran
Kumar, Shiva
Whipple's Disease (WD) Without Arthropathy in an Immunocompromised Patient
title Whipple's Disease (WD) Without Arthropathy in an Immunocompromised Patient
title_full Whipple's Disease (WD) Without Arthropathy in an Immunocompromised Patient
title_fullStr Whipple's Disease (WD) Without Arthropathy in an Immunocompromised Patient
title_full_unstemmed Whipple's Disease (WD) Without Arthropathy in an Immunocompromised Patient
title_short Whipple's Disease (WD) Without Arthropathy in an Immunocompromised Patient
title_sort whipple's disease (wd) without arthropathy in an immunocompromised patient
topic Internal Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9761016/
https://www.ncbi.nlm.nih.gov/pubmed/36545168
http://dx.doi.org/10.7759/cureus.31659
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