Fourteen years of severe arthralgia in a man without gastrointestinal symptoms: atypical Whipple's disease

Abstract

We report here the case of Whipple's disease in a 60-year-old man with severe arthralgia and systemic disorders but without gastrointestinal manifestations. The patient had different clinical diagnoses over a period of 14 years. We identified Tropheryma whipplei by real-time PCR. Molecular typing was also performed by sequencing the 16S-23S rRNA intergenic spacer region and domain III of the 23S rRNA gene.

FIG. 1.

Histology of the intestinal biopsies stained with the PAS reagent (magnification, ×40). Shown are a sample from 2001 (A) and a sample from 2008 (B). Photographs show intestinal lamina propria infiltrated with macrophages with PAS-positive inclusions (asterisks). Deposits of lipid droplets are illustrated as empty spaces.

FIG. 2.

Sequence analysis alignment (partial sequences) of the two biopsy samples (from 2001 and 2008) with the 16S-23S rRNA intergenic spacer region (type 2) and the 23S rRNA domain III (type A). Dots and underlined letters symbolize identity and target nucleotides, respectively. *, GenBank accession no. AF100950; **, GenBank accession no. AF148136.