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Rheumatology Advance Access published online on February 28, 2003
Rheumatology, doi:10.1093/rheumatology/keg148
Rheumatology © British Society for Rheumatology 2003; all rights reserved
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© 2003 British Society for Rheumatology

Grand Rounds in Rheumatology

Whipple arthritis: diagnosis by molecular analysis of synovial fluid--current status of diagnosis and therapy

U. Lange 1* J. Teichmann 2

1 Kerckhoff Clinic and Foundation, Department of Rheumatology, Bad Nauheim
2 III Medical Clinic, University of Giessen, Giessen, Germany

* Corresponding author. E-mail: uwe.lange{at}kerckhoff.med.uni-giessen.de.

Received 5 December 2001 ; accepted 4 September 2002

Abstract

Whipple's disease (WD) is an uncommon polysystem infectious disease. In the present report, we describe a patient who presented with a chronic illness consistent with WD and an avascular necrosis of the right hip joint. WD and its proposed causative bacillus, Tropheryma whippelii, was identified by molecular analysis (polymerase chain reaction) in bacterial DNA extracted from the synovial fluid. The diagnosis was additionally confirmed by upper gastrointestinal endoscopy and a small bowel biopsy with macrophages positive for periodic acid-Schiff reagent demonstrated by light and electron microscopy.

This demonstrates that WD can be diagnosed without tissue biopsy. False diagnosis of the polymorphous signs and symptoms of WD can lead to invalidism and even death, whereas correct therapy leads to a cure in most cases. Thus, the current status of diagnosis and therapy is of key importance in the treatment of WD.

Key words: Whipple's disease, Infectious disease, Actinomycete.
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