Case of Whipple’s Disease

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Whipple's disease
Figure 1. Upper gastrointestinal endoscopy on readmission. Yellow, shaggy mucosa alternating with erythematous, eroded mucosa in the duodenum.

Early sign of Whipple’s Disease: isolated knee arthritis

This article describes a case of Whipple’s disease in patient with isolated knee arthritis. The 64-year-old female patient initially presented to the orthopedic outpatient clinic after being referred by her rheumatologist. She complained of a 4-week history of knee pain and swelling, also, for which she was prescribed anti-inflammatory drugs. The patient complained that with time her pain became worse and she stopped responding to pain medications. Therefore, she decided to consult a rheumatologist.

On examination, clinical signs of arthritis were evident. According to her history, the knee pain presumably started 4 years earlier after a skiing accident. An analysis of synovial fluids was significant for high inflammatory effusion, predominantly with mononuclear cells. However, no crystals were identified. In addition, the culture was negative for signs of bacterial growth. There was no family history of monoarthritis.

She was referred to the outpatient clinic for further evaluation and diagnostic arthroscopy.

The patient was diagnosed with breast cancer in 2007, for which she underwent quadrantectomy and radiotherapy in 2008. She had no other preexisting illnesses and was not on any regular medications. In addition, she had no history of corticostoids or chemotherapy for her breast carcinoma. Her surgery and radiotherapy had taken 10 years ago.

The patient presented as afebrile with good general condition. She was able to walk for short distances with support from crutches. Examination showed a warm left knee which was painful on palpation, accompanied with reduced passive and active ROM party because of the pain. All other clinical examination were normal.

Doctors advised an MRI of the knee which for significant for grade II patellar chondropathy and grade IV chondropathy of the femoral trochlea and diffuse reactive synovitis. All laboratory tests performed before surgery were within normal limits. A second arthroscopy was done 5 days later because of the appearance of intra-articular hematoma. One of the rheumatologists advised looking for T. whipplei. And PCR testing came back as positive, confirming the diagnosis of Whipple’s disease.

She was prescribed empiric antibiotic therapy with ceftriaxone and co-trimoxazole. Follow-up after two months showed favourable recovery. Similarly, 14 months after the patient had no recurrence of knee arthritis and was living a good quality life.

References

Isolated Knee Arthritis as Early and Only Symptom of Whipple’s Disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994299/

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.

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