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Palindromic rheumatism: consider W hipple's disease

Palindromic rheumatism: consider W hipple's disease Dear Editor Whipple's disease is a rare multisystem infectious disease caused by Tropheryma whipplei . Up to 15% of patients with Whipple's disease present with non‐specific symptoms and the diagnosis is often missed or significantly delayed. Patient A, a 50‐year‐old man, was referred because of weekly episodes of fever and arthritis of his left wrist. Because of these complaints, he was referred to a rheumatologist two and a half years before presentation to our outpatient clinic and diagnosed with palindromic rheumatism. Examination during episodes of fever showed redness of his left wrist accompanied by pain and stiffness, indicating arthritis. Laboratory data revealed increased erythrocyte sedimentation rate (ESR) of 56 mm (normal < 20 mm). Rheumatoid factor and anti‐citrullinated protein (anti‐CCP) were negative. Common infectious agents such as human immunodeficiency virus and Borrelia were ruled out and Whipple's disease was considered. Microscopy for periodic acid‐Schiff (PAS)‐positive macrophages was negative. However, polymerase chain reaction (PCR) of duodenal biopsy specimen was positive for Tropheryma whipplei . A diagnosis of possible Whipple's disease was made and a clinical trial with trimethoprim–sulfamethoxazol was initiated. Within 2 weeks his complaints resolved. His ESR returned to normal within 6 months. After 1 year of treatment, http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png International Journal of Rheumatic Diseases Wiley

Palindromic rheumatism: consider W hipple's disease

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Publisher
Wiley
Copyright
International Journal of Rheumatic Diseases © 2013 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd
ISSN
1756-1841
eISSN
1756-185X
DOI
10.1111/1756-185X.12084
pmid
23992271
Publisher site
See Article on Publisher Site

Abstract

Dear Editor Whipple's disease is a rare multisystem infectious disease caused by Tropheryma whipplei . Up to 15% of patients with Whipple's disease present with non‐specific symptoms and the diagnosis is often missed or significantly delayed. Patient A, a 50‐year‐old man, was referred because of weekly episodes of fever and arthritis of his left wrist. Because of these complaints, he was referred to a rheumatologist two and a half years before presentation to our outpatient clinic and diagnosed with palindromic rheumatism. Examination during episodes of fever showed redness of his left wrist accompanied by pain and stiffness, indicating arthritis. Laboratory data revealed increased erythrocyte sedimentation rate (ESR) of 56 mm (normal < 20 mm). Rheumatoid factor and anti‐citrullinated protein (anti‐CCP) were negative. Common infectious agents such as human immunodeficiency virus and Borrelia were ruled out and Whipple's disease was considered. Microscopy for periodic acid‐Schiff (PAS)‐positive macrophages was negative. However, polymerase chain reaction (PCR) of duodenal biopsy specimen was positive for Tropheryma whipplei . A diagnosis of possible Whipple's disease was made and a clinical trial with trimethoprim–sulfamethoxazol was initiated. Within 2 weeks his complaints resolved. His ESR returned to normal within 6 months. After 1 year of treatment,

Journal

International Journal of Rheumatic DiseasesWiley

Published: Aug 1, 2013

References