Presse Med. 2005 Nov 19;34(20 Pt 1):1521-4. Related Articles, Links
[Whipple disease, initially diagnosed as sarcoidosis]
[Article in French]
Saba M, Rollot F, Park S, Grimaldi D, Sicard D, Abad S, Blanche P.
Service de medecine interne 2 du Pr D. Sicard, Universite Rene
Descartes, Hopital Cochin, Paris. sabamona@...
INTRODUCTION: Whipple disease is a multisystem infectious disease
caused by Tropheryma whipplei. We report a case in which an initial
diagnosis of sarcoidosis was changed to Whipple disease
endocarditis. CASE: Based on clinical, radiographic, endoscopic and
histologic findings, this 61-year-old man was diagnosed with
sarcoidosis. Initial response to corticotherapy was good, but the
patient required 35 mg of prednisone daily. The subsequent onset of
clinical and laboratory signs of inflammation cast doubt on the
diagnosis. After cardiac ultrasound revealed a mass 1 cm in diameter
on the mitral valve, apparently vegetation, we diagnosed culture-
negative infective endocarditis and ruled out most possible causes.
PCR of a duodenal biopsy sample showed Tropheryma whipplei, thus
confirming the diagnosis of Whipple disease, despite normal
histological findings. After 3 weeks of intravenous gentamicin and
amoxicillin treatment, oral cotrimoxazole was substituted. Follow-up
transesophageal ultrasound showed no mitral vegetation. The patient,
still under cotrimoxazole, has been off prednisone for 13 months and
is completely asymptomatic. CONCLUSION: This case is an illustration
of the difficulty in distinguishing Whipple disease from sarcoidosis
in practice and of the importance of that distinction.
Publication Types:
Case Reports
PMID: 16301965 [PubMed - indexed for MEDLINE
[Whipple disease, initially diagnosed as sarcoidosis]
[Article in French]
Saba M, Rollot F, Park S, Grimaldi D, Sicard D, Abad S, Blanche P.
Service de medecine interne 2 du Pr D. Sicard, Universite Rene
Descartes, Hopital Cochin, Paris. sabamona@...
INTRODUCTION: Whipple disease is a multisystem infectious disease
caused by Tropheryma whipplei. We report a case in which an initial
diagnosis of sarcoidosis was changed to Whipple disease
endocarditis. CASE: Based on clinical, radiographic, endoscopic and
histologic findings, this 61-year-old man was diagnosed with
sarcoidosis. Initial response to corticotherapy was good, but the
patient required 35 mg of prednisone daily. The subsequent onset of
clinical and laboratory signs of inflammation cast doubt on the
diagnosis. After cardiac ultrasound revealed a mass 1 cm in diameter
on the mitral valve, apparently vegetation, we diagnosed culture-
negative infective endocarditis and ruled out most possible causes.
PCR of a duodenal biopsy sample showed Tropheryma whipplei, thus
confirming the diagnosis of Whipple disease, despite normal
histological findings. After 3 weeks of intravenous gentamicin and
amoxicillin treatment, oral cotrimoxazole was substituted. Follow-up
transesophageal ultrasound showed no mitral vegetation. The patient,
still under cotrimoxazole, has been off prednisone for 13 months and
is completely asymptomatic. CONCLUSION: This case is an illustration
of the difficulty in distinguishing Whipple disease from sarcoidosis
in practice and of the importance of that distinction.
Publication Types:
Case Reports
PMID: 16301965 [PubMed - indexed for MEDLINE
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