Gewichtsverlust, Niereninsuffizienz, Aortenvitium und Arthralgien

Kleine, G

doi:10.1007/s00108-005-1375-z

Cited by 3 publications

(1 citation statement)

References 8 publications

(5 reference statements)

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“…No type of article or language restriction was set. Overall 107 papers on Whipple disease were identified, of which 2 reports concerned deterioration of renal function [7-8], 1 report generalized amyloidosis [9] and 5 reports renal amyloidosis (confirmed by histopathology) [10-14]. None of the patients with renal amyloidosis required dialysis or there was lack of such data.…”

Section: Discussionmentioning

confidence: 99%

Renal amyloidosis in Whipple disease: a case report

Niemczyk

Filipowicz

Woźniacki

et al. 2009

Cases J

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IntroductionWhipple disease is a rare systemic infection caused by Tropheryma whippelii that usually manifests with joint pain, weight loss, diarrhoea and abdominal pain. However, in some cases the infection may involve other organs and tissues.Case presentationWe report on a 44-year-old man with Whipple disease which led to renal amyloidosis and end-stage renal failure. In this case, the patient was diagnosed with Whipple disease and commenced on a 12-month trimetoprime-sulfametoxasole therapy with good result. Six months after cessation of therapy the patient was readmitted to hospital due to signs of renal failure. An urgent kidney biopsy was performed which revealed secondary amyloidosis. Despite intensive immunosuppressive treatment, renal parameters gradually deteriorated and haemodialysis was started eventually. Three months later the patient’s general condition dramatically worsened with bloody diarrhoea, bilious vomiting and progressive malnutrition. The repeated endoscopic examination confirmed severe recurrence of Whipple disease. Ceftriaxone and total parenteral nutrition was started what greatly improved patient’s state.ConclusionsTo our knowledge based on systematic review, this is the first case report on Whipple disease complicated by secondary amyloidosis and kidney failure maintained on permanent renal replacement therapy. It is strongly suspected that the use of immunosuppressive treatment in such cases may exacerbate the course of Whipple disease and cause life-threatening complications.

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Section: Discussionmentioning

confidence: 99%

Renal amyloidosis in Whipple disease: a case report

Niemczyk

Filipowicz

Woźniacki

et al. 2009

Cases J

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Oligoarthritis durch Tropheryma whipplei

et al. 2010

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Whipple's disease is a rare, chronic infection caused by Tropheryma whipplei, an ubiquitary gram positive bacterium. The disease is associated with a high mortality in absence of an antibiotic treatment. The disease can be detected in affected tissues and body fluids by light and electron microscopy, as well as by polymerase chain reaction (PCR). Musculoskeletal symptoms such as arthralgia and arthritis frequently represent the first manifestation of this multi-system disease; typical subsequent symptoms are weight loss, diarrhea, and abdominal pain. Symptoms of central nervous system involvement are present in 10-40% of cases. We report on a 67 year-old male with a history of migratory oligoarthritis over three decades in whom the causative agent was detected by PCR in synovial fluid only. This case illustrates that searches for the characteristic PAS-positive macrophages and PCR in biopsies from the duodenum may be insufficient and that diagnostic efforts should be complemented with PCR assays from affected tissues or body fluids. It is recommended that antibiotic treatment be carried out with an agent that penetrates well into the cerebrospinal fluid, e.g. ceftriaxone, followed by cotrimoxazole. Antibiotics should be maintained over several months to years. It is prudent to document the disappearance of the pathogen in the affected compartments prior to the discontinuation of the antibiotic therapy.

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Renal transplantation in AA amyloidosis associated with Whipple’s disease

Rocha

Lobato²,

Carvalho³

et al. 2011

Amyloid

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Whipple's disease (WD) is a chronic infection caused by Thropheryma whipplei that usually manifests with intestinal, articular, pulmonary, neurological and cardiac abnormalities. Rarely, WD has been associated with renal AA amyloidosis.We report a 50 year-old male with nephrotic syndrome and renal failure whose renal biopsy revealed extensive AA amyloidosis. Amyloid was not found in other organs, namely in gastrointestinal tract and bone marrow. There was no evidence of chronic inflammatory disease, and despite detailed investigation, the diagnosis of the underlying disease remained obscure. Eight months after referral he started peritoneal dialysis. Three years later he developed anorexia, weight loss, anemia, and recurrent attacks of non-bloody diarrhea. A biopsy of the small intestine showed typical histological findings of WD and PCR was positive for T. whipplei. He was treated with ceftriaxone followed by co-trimoxazole, with remission of complaints and histological features. Three years later the patient underwent successful cadaveric kidney transplantation. In this case, AA amyloidosis preceded the manifestations of WD. To the best of our knowledge, this is the first report of kidney transplantation in a patient with amyloidosis due to WD. Recurrence of amyloidosis in renal graft is not expected.

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Gewichtsverlust, Niereninsuffizienz, Aortenvitium und Arthralgien

Cited by 3 publications

References 8 publications

Renal amyloidosis in Whipple disease: a case report

Renal amyloidosis in Whipple disease: a case report

Oligoarthritis durch Tropheryma whipplei

Renal transplantation in AA amyloidosis associated with Whipple’s disease

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