Whipple’s disease is a chronic multisystem disorder caused by infection with the rod-shaped bacterium, Tropheryma whippelii. We report the case of a 65-year-old woman with intestinal Whipple’s disease that had been refractory to monotherapy with a number of antibiotics over a 2-year period. The patient then presented with watery diarrhoea, cachexia (body mass index 18 kg/m2) and chronic anaemia (haemoglobin 7.6 g/dl). Wireless capsule endoscopy showed that the disease affected the entire small intestine. Focal occult areas of bleeding were observed in different parts of the jejunum. The capsule’s transit time through the small intestine was 2 hours 43 minutes. Capsule endoscopy allows novel insights into the pathophysiology of Whipple’s disease.
References
-
1 Maiwald M, von Herbay A, Relman D A. Whipple’s Disease. In: Feldman M, Friedman LS, Sleisenger MH (eds) Sleisenger & Fordtran’s gastrointestinal and liver disease. 7th edn. Philadelphia; Saunders 2002: 1854-1863
-
2
Bentley S D, Maiwald M, Murphy L D. et al .
Sequencing and analysis of the genome of the Whipple’s disease bacterium Tropheryma whipplii.
.
Lancet.
2003;
361
637-644
-
3
von Herbay A, Otto H F.
Whipple’s disease: a report of 22 patients.
Klin Wochenschr.
1988;
66
533-539
-
4
Fleming J L, Wiesner R H, Shorter R G.
Whipple’s disease: clinical, biochemical, and histopathologic features and assessment of treatment in 29 patients.
Mayo Clin Proc.
1988;
63
539-551
-
5
Durand D V, Lecomte C, Cathebras P. et al .
Whipple’s disease: clinical review of 52 cases.
Medicine.
1997;
76
170-184
-
6
Geboes K, Ectors N, Heidbuchel H. et al .
Whipple’s disease: endoscopic aspects before and after therapy.
Gastrointest Endosc.
1990;
36
247-252
-
7
von Herbay A, Maiwald M, Ditton H J, Otto H F.
Histology of intestinal Whipple’s disease revisited: study of 48 patients.
Virchows Arch.
1996;
429
335-343
-
8
von Herbay A, Ditton H J, Maiwald M.
Diagnostic application of a polymerase chain reaction assay for the Whipple’s disease bacterium to intestinal biopsies.
Gastroenterology.
1996;
110
1735-1743
-
9
Ramzan N N, Loftus E Jr, Burgart L J. et al .
Diagnosis and monitoring of Whipple disease by polymerase chain reaction.
Ann Intern Med.
1997;
126
520-527
-
10
Pron B, Poyart C, Abachin E. et al .
Diagnosis and follow-up of Whipple’s disease by amplificatrion of the 16S rRNA gene of Tropheryma whippelii.
.
Eur J Clin Microbiol Infect Dis.
1999;
18
62-65
-
11
Maiwald M, von Herbay A, Persing D H. et al .
Tropheryma whippelii DNA is rare in the intestinal mucosa of patients without other evidence of Whipple’s disease.
Ann Int Med.
2001;
134
115-119
-
12 Dobbins W O III. Whipple’s disease. Springfield, Illinois; Thomas 1987
-
13
von Herbay A, Ditton H J, Schuhmacher F, Maiwald M.
Whipple’s disease: staging and monitoring by cytology and polymerase chain reaction analysis of cerebrospinal fluid.
Gastroenterology.
1997;
113
434-441
-
14
Iddan G, Meron G, Glukhovsky A, Swain P.
Wireless capsule endoscopy.
Nature.
2000;
405
417-418
-
15 von Herbay A. Whipple’s disease online. Available from: URL: http://www.WhipplesDisease.net [Accessed 10 - 01 - 2004].
-
16
Schneider T, Stallmach A, von Herbay A. et al .
Treatment of refractory Whipple’s disease with interferon gamma.
Ann Intern Med.
1998;
129
875-877
-
17
Feldman M, Price G.
Intestinal bleeding in patients with Whipple’s disease.
Gastroenterology.
1989;
96
1207-1209
-
18
Ell C, Remke S, May A. et al .
The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding.
Endoscopy.
2002;
34
685-689
-
19
Saurin J C, Delvaux M, Gaudin J L. et al .
Diagnostic value of endoscopic capsule in patients with obscure digestive bleeding: blinded comparison with video push-enteroscopy.
Endoscopy.
2003;
35
576-584
-
20
Mylonaki M, Fritscher-Ravens A, Swain P.
Wireless capsule endoscopy: a comparison with push enteroscopy in patients with gastroscopy- and colonoscopy-negative gastrointestinal bleeding.
Gut.
2003;
52
1122-1126
-
21
Enzinger F M, Helwig E B.
Whipple’s disease: a review of the literature and report of 15 patients.
Virchows Arch.
1963;
336
238-269
-
22
Ung K A, Havel G, Claesson B. et al .
Whipple’s disease can be diagnosed using paraffin-embedded specimens from the ileum obtained during ileocolonoscopy.
Endoscopy.
2003;
35
632
A. von Herbay, M. D
Pathologisches Institut · Universitätsklinikum
Im Neuenheimer Feld 220 · 69120 Heidelberg · Germany
Email: vonHerbay@WhipplesDisease.net
