Whipple's Disease With Cardiac and Renal Abnormalities

Kraunz, Robert F.

doi:10.1001/archinte.1969.00300160091015

Cited by 26 publications

(9 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The key to the diagnosis of Whipple's dis ease remains the histologic finding of widen ing of the small intestinal villi with foamy macrophages in the lamina propria filled with periodic acid-Schiff (PAS) staining, diastase-resistant material accompanied by lymphatic dilatation [4,11], In these macro phages, PAS-positive rod-shaped organisms (Whipple bacilli [32]) can be demonstrated by electron microscopy. However, definite diagnosis can be made only after the exclu sion of an intracellular infection with Myco bacterium avium.…”

Section: Diagnosismentioning

confidence: 99%

“…In general, immuno globulin levels are normal in Whipple's dis ease [4,[49][50][51][52][53], except IgA which is found elevated in some patients before treatment. The normalisation during treatment suggests that the elevation is due to host response to the Whipple's disease pathogen.…”

Section: Immunologic Findingsmentioning

confidence: 99%

“…The normalisation during treatment suggests that the elevation is due to host response to the Whipple's disease pathogen. Secretory IgA levels in saliva and intestinal secretions, however, are normal [49,50], Immunofluorescent studies of small intestinal biopsies also do not reveal consistent abnormalities [4,49]. Before treatment, plasma cells are more likely to be decreased, but they tend to return to normal after treatment.…”

Section: Immunologic Findingsmentioning

confidence: 99%

“…Fever of unknown origin and migratory arthralgia may precede the intesti nal symptoms for some years [3][4][5][6][7][8][9][10]. Despite characteristic intestinal histopathology, gas trointestinal symptoms have been minimal in many reported cases.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Whipple’s Disease: A Multisystemic Disease with Changing Presentation

Marbet¹,

Stalder²,

Gyr³

1986

Dig Dis

View full text Add to dashboard Cite

Section: Diagnosismentioning

confidence: 99%

Section: Immunologic Findingsmentioning

confidence: 99%

Section: Immunologic Findingsmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Whipple’s Disease: A Multisystemic Disease with Changing Presentation

Marbet¹,

Stalder²,

Gyr³

1986

Dig Dis

View full text Add to dashboard Cite

“…The characteristic cytoplasmic granules are clumps of T whippelii (approximately 2 µm in length and 0.2 µm in diameter) and their degradation products. These pathognomonic PAS positive macrophages may also be present in the peripheral and mesenteric lymph nodes, liver, spleen, heart valves, brain, and lungs, [18][19][20][21] eye and spinal cord, 22 and occasionally in the synovium. 23 Another characteristic feature in small bowel biopsies is rounded empty spaces scattered through the lamina propria which contain neutral fat, described as intestinal lipodystrophy by Whipple in 1907.…”

mentioning

confidence: 99%

Whipple's disease

Ratnaike

2000

Postgrad Med J

View full text Add to dashboard Cite

Whipple's disease is a systemic bacterial infection and the common though not invariable manifestations are diarrhoea, weight loss, abdominal pain, and arthralgia. Arthritis or arthralgia may be the only presenting symptom, predating other manifestations by years. Virtually all organs in the body may be aVected, with protean clinical manifestations. Various immunological abnormalities, some of which may be epiphenomena, are described. The causative organism is Tropheryma whippelii.The disease is uncommon though lethal if not treated. Recent data suggest the disease occurs in an older age group than previously described. The characteristic histopathological features are found most often in the small intestine. These are variable villous atrophy and distension of the normal villous architecture by an infiltrate of foamy macrophages with a coarsely granular cytoplasm, which stain a brilliant magenta colour with PAS. These pathognomonic PAS positive macrophages may also be present in the peripheral and mesenteric lymph nodes and various other organs. The histological diVerential diagnoses include histoplasmosis and Mycobacterium aviumintercellulare complex.The clinical diagnosis of Whipple's disease may be elusive, especially if gastrointestinal symptoms are not present. A unique sign of CNS involvement, if present, is oculofacial-skeletal myorhythmia or oculomasticatory myorhythmia, both diagnostic of Whipple's disease. A small bowel biopsy is often diagnostic, though in about 30% of patients no abnormality is present. In patients with only CNS involvement, a stereotactic brain biopsy can be done under local anaesthetic. A recent important diagnostic test is polymerase chain reaction of the 16S ribosomal RNA of Tropheryma whippelii.Whipple's disease is potentially fatal but responds dramatically to antibiotic treatment. In this review the current recommended treatments are presented. The response to treatment should be monitored closely, as relapses are common. CNS involvement requires more vigorous treatment because there is a high rate of recurrence after apparently successful treatment. (Postgrad Med J 2000;76:760-766)

show abstract

A case of refractory rheumatoid pericarditis

Makol¹,

Maleszewski²,

Warrington³

2012

Arthritis Care & Research

View full text Add to dashboard Cite

A 63-year-old man with an outside diagnosis of rheumatoid arthritis (RA) presented to our medical center for new-onset, progressively worsening dyspnea (New York Heart Association class IV), abdominal bloating, and peripheral edema for 3-4 weeks prior to presentation. A chest radiograph showed mild enlargement of the cardiac silhouette with pulmonary venous hypertension, mild pulmonary edema, and small pleural effusions. Electrocardiogram showed atrial flutter with a 3:1 atrioventricular conduction, left anterior fascicular block, and a prolonged QT interval. A transthoracic echocardiogram (TTE) revealed severe constrictive pericarditis (CP) with pronounced diastolic flow reversal in the hepatic veins. There was no evidence of an intracardiac mass or thrombus. The left ventricular ejection fraction was normal at 70%. He was hospitalized for further evaluation of congestive heart failure (CHF). Physical ExaminationUpon arrival at our hospital, the patient was alert and oriented, but appeared fatigued and deconditioned. His blood pressure was 128/88 mm Hg, pulse was 80 -98 beats/ minute, and oxygen saturation was 94% on oxygen 3 liters/ minute by nasal cannula. His jugular venous pressure was elevated. Lung fields showed coarse crepitations at the bases bilaterally. Cardiac examination revealed a 2ϩ right ventricular heave and normal S1 and S2 with intermittent diastolic filling sounds at the apex. No arterial bruits were evident and peripheral pulses were normal. Lower extremities had pitting edema up to the thighs. Mild ascites was noted on the abdominal examination. No hepatosplenomegaly or lymphadenopathy was detected. The skin and neurologic examination was normal. The joint examination did not show any evidence of active synovitis. Medical and Surgical HistoryHe had well-controlled hypertension and hyperlipidemia. There was no history of coronary artery disease, cardiac arrhythmias, acute pericarditis, or CHF. RA was diagnosed 20 years prior with predominantly large joint involvement (hips and ankles) in the setting of elevated inflammatory markers and a positive rheumatoid factor (RF). He was originally treated with methotrexate that was discontinued for unknown reasons. Azathioprine and adalimumab were used briefly and discontinued due to inefficacy. He eventually underwent bilateral total hip arthroplasties but had no apparent extraarticular manifestations until his current presentation. Medications Prior to PresentationThe patient was taking aspirin 325 mg daily, nebivolol 5 mg daily, simvastatin 40 mg at bedtime, pantoprazole 40 mg daily, vitamin D 400 IU, and a multivitamin. For RA, he was receiving prednisone 8 mg daily and celecoxib 200 mg once daily. Family and Social HistoryHe was married and worked full time. He smoked up to 15 cigars in a year and drank beer 3-4 times a week. He had a family history of premature coronary artery disease in his father (diagnosed in his 50s), who died from colon cancer. Review of SystemsHis symptoms were not preceded by a viral prodrome. He denied rhinorrhea, cough,...

show abstract

Whipple's Disease With Cardiac and Renal Abnormalities

Cited by 26 publications

References 14 publications

Whipple’s Disease: A Multisystemic Disease with Changing Presentation

Whipple’s Disease: A Multisystemic Disease with Changing Presentation

Whipple's disease

A case of refractory rheumatoid pericarditis

Contact Info

Product

Resources

About