#MayoIDCase
52M in MN is referred for FUO.
A year ago: fatigue + migratory polyarthritis of hips, knees, elbows - Rx: prednisone —> MTX: no response
Now: F/C, abd pain, 50-lb wt loss, pleuropericarditis
HIV(-). No travel. Office work. No outdoors.
#MayoIDQ DDx and work up?
52M in MN is referred for FUO.
A year ago: fatigue + migratory polyarthritis of hips, knees, elbows - Rx: prednisone —> MTX: no response
Now: F/C, abd pain, 50-lb wt loss, pleuropericarditis
HIV(-). No travel. Office work. No outdoors.
#MayoIDQ DDx and work up?
2/
#MayoIDQ What is the most likely pathogen in this 52M with over a year of migratory polyarthritis not responsive to steroid and methotrexate? Now with fever, sweats, abdominal pain, weight loss, and serositis. HIV negative. No outdoors and travel history.
#MayoIDQ What is the most likely pathogen in this 52M with over a year of migratory polyarthritis not responsive to steroid and methotrexate? Now with fever, sweats, abdominal pain, weight loss, and serositis. HIV negative. No outdoors and travel history.
3/
Case diagnosis: #Whipple’s disease due to #Tropheryma #whipplei
Diagnostic test: PCR for T whipplei in the blood
Rx: Ceftriaxone as initial Rx, followed by prolonged TMP-SMX
Clinical improvement with resolution of polyarthralgia / FUO / weight gain
Case diagnosis: #Whipple’s disease due to #Tropheryma #whipplei
Diagnostic test: PCR for T whipplei in the blood
Rx: Ceftriaxone as initial Rx, followed by prolonged TMP-SMX
Clinical improvement with resolution of polyarthralgia / FUO / weight gain
4/
#Whipple’s disease in this man was misdiagnosed as “inflammatory arthritis” which did not respond to steroid and MTX
All immunosuppressive drugs were discontinued upon Whipple’s diagnosis.
Similar cases mimicking seronegative RA have been reported.
ojrd.biomedcentral.com
#Whipple’s disease in this man was misdiagnosed as “inflammatory arthritis” which did not respond to steroid and MTX
All immunosuppressive drugs were discontinued upon Whipple’s diagnosis.
Similar cases mimicking seronegative RA have been reported.
ojrd.biomedcentral.com
5/
#Whipple’s disease
- T. whipplei affects organs, notably GI tract
- Suspect: middle aged white man w/ “arthritis, GI symptoms, weight loss”
- Dx: biopsy - PAS-positive foamy macrophages; PCR
- Rx: Ceftriaxone then TMP-SMX or doxycycline+hydroxychloroquine
- Relapses common
#Whipple’s disease
- T. whipplei affects organs, notably GI tract
- Suspect: middle aged white man w/ “arthritis, GI symptoms, weight loss”
- Dx: biopsy - PAS-positive foamy macrophages; PCR
- Rx: Ceftriaxone then TMP-SMX or doxycycline+hydroxychloroquine
- Relapses common
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