Z Gastroenterol 2012; 50 - P11
DOI: 10.1055/s-0032-1313850

Is the bacterium Tropheryma whipplei cause of the disease in a subgroup of patients with presumed sarcoidosis?

E Dulic-Lakovic 1, M Hubner 2, C Müller 3, W Pokieser 4, M Dulic 1, S Publig 2, M Kneussl 2, M Gschwantler 1
  • 1Department of Internal Medicine IV, Wilhelminenspital, Vienna, Austria
  • 2Department of Internal Medicine II, Wilhelminenspital, Vienna, Austria
  • 3Department of Internal Medicine III, AKH & Medical University Vienna, Vienna, Austria
  • 4Institute of Pathology and Bacteriology, Wilhelminenspital, Vienna, Austria

Introduction: Sarcoidosis is a granulomatous multiorgan disease of unknown cause. Recently we published a case report presenting a patient in whom a causal relationship between pulmonary sarcoidosis and infection with Tropheryma whipplei (T. whipplei) could be demonstrated1. To our best knowledge this is the first systematic study investigating the hypothesis, that in a subgroup of patients presumed sarcoidosis is caused by T. whipplei.

Patients and Methods: A total of 56 consecutive patients in whom a diagnosis of sarcoidosis was suspected clinically and confirmed histologically were included in this retrospective study. The study population comprised 21 male and 35 female patients, mean age±SD=53.6±16.2 (range 24–90) years.

PCR-examination for T. whipplei (which detects species-specific bacterial-ribosomal RNA) was performed in all patients, using formalin-fixed and paraffin-embedded specimens obtained from organs affected by sarcoidosis. Specimens were obtained from the following tissues: lung (n=22), lymph nodes (n=15), skin (n=7), liver (n=6) and other organs (n=6). All PCR-examinations were done in an international reference laboratory for Whipple's disease with extensive experience in this field.

Results: T. whipplei-RNA was detected in tissues affected by sarcoidosis in 2 of 56 patients (3.6%). Both patients with a positive PCR were women (age: 32 and 85 years, respectively) and had enlarged mediastinal and hilar lymph nodes. Histological examination of affected lymph nodes showed granulomatous lymphadenitis of sarcoid type, PAS-staining was negative. Both patients had no gastrointestinal symptoms. Further evaluation for the presence of Whipple's disease in these two patients is ongoing.

Conclusion: Our findings contribute further evidence to the hypothesis, that in a subgroup of patients presumed sarcoidosis is caused by infection with the bacterium T. whipplei. However, this hypothesis should be further evaluated in prospective studies.

1 Dzirlo L, Hubner M, Müller C, Blaha B, Formann E, Dellinger C, Petzelbauer P, Müllauer L, Huber K, Kneussl M, Gschwantler M. A mimic of sarcoidosis. Lancet 2007; 369:1832.