Tropheryma whipplei infection (Whipple's disease) in a patient after liver transplantation

Abstract

Whipple's disease (WD) is a rare infection caused by the bacterium Tropheryma whipplei that can affect multiple organs and most commonly occurs in the immunocompetent host. Only 3 cases of WD have been reported in the setting of immunosuppression for organ transplantation. Here, we report the first case of WD, to our knowledge, in a patient after liver transplantation with comorbid graft-versus-host-disease. We discuss the diagnostic challenges in this setting and the value of electron microscopy and in situ hybridization methods for confirming the infection. WD may be under-diagnosed in immunosuppressed transplant patients because the disease can present with atypical clinical and histological features that suggest other conditions.

Malabsorption Syndrome Due to Tropheryma Whipplei Severe Infection in a Patient Thirteen Years after Kidney Transplantation

“…Furthermore, before that episode, the patient received Imipenem as a treatment of urinary tract infections caused by pseudomonas aeruginosa. In the literature, the treatment with antibiotics such as carbapenem antibiotic family, as in the above case may also partially treat or provide prophylaxis against WD [7]. But no enough data are available to prove that a lifelong prophylaxis treatment of WD in renal recipients might be prudent, safe and avoid the relapses.…”

“…All of those cases have occurred in patients having an inflammatory state due to another process affecting the site of Whipple's manifestation. It is possible then that WD risk increases with disruption of innate immunological defenses, such as barrier function and mucosal immunity of the affected tissue by other infections or inflammatory processes [7]. In the liver recipient case, the WD was following liver transplantation with comorbid graft-versus-host disease (GVHD) both affecting the gastrointestinal tract (Table 1) [7].…”

“…It is possible then that WD risk increases with disruption of innate immunological defenses, such as barrier function and mucosal immunity of the affected tissue by other infections or inflammatory processes [7]. In the liver recipient case, the WD was following liver transplantation with comorbid graft-versus-host disease (GVHD) both affecting the gastrointestinal tract (Table 1) [7]. Table 1: characteristics of all the reported cases of WD after solid organ transplantation.…”

“…The diagnosis of WD is suggested by duodenal biopsy when histology shows periodic acid-Schiff (PAS)-positive foamy macrophages, and can be confirmed by T. Whipplei directed polymerase chain reaction (PCR) [7]. WD is potentially easily treatable, the most widely antibiotic regimen being used is a 2 week initial course of ceftriaxone, followed by oral cotrimoxazole for 12-18 months [8].…”

Whipple's disease in renal transplant recipients: Management experience of seven cases from Pakistan

“…However, WD can have protean manifestations and can involve any organ of the body including the cardiovascular system with culture-negative endocarditis, or the central nervous system. 4 Mahnel et al, 5 in a comparative study of WD, found that patients who were on immunosuppres-sive medications for possible arthropathies were more likely to develop severe diarrhea leading to the diagnosis of WD. T. whipplei is considered an opportunistic pathogen that persists in duodenal macrophages.…”