Kalliopi Foteinogiannopoulou1, Ioannis Mouzas2, Maria Tzardi3, Eleni Orfanoudaki1, Eirini Theodoraki1, Diamantis Kofteridis4. 1. MD, Gastroenterology Department, University General Hospital of Heraklion, Voutes, Heraklion, Crete, zip code 71110, Greece. 2. MD, PhD, Gastroenterology Department, University General Hospital of Heraklion, Voutes, Heraklion, Crete, zip code 71110, Greece. 3. MD, PhD, Pathology Department, University General Hospital of Heraklion, Voutes, Heraklion, Crete, zip code 71110, Greece. 4. Internal Medicine Department, University General Hospital of Heraklion, Crete, zip code 71110, Greece.
Abstract
INTRODUCTION: Whipple's disease is a rare chronic infectious disease caused by Tropheryma whipplei. The infection mainly affects the small intestine of middle-aged patients, approximately three times more often in males than in females causing malabsorption and excessive weight loss but other organs may be affected as well. CASE REPORT: We describe a case of a 42-year-old woman with a history of chronic diarrhea and weight loss evolving for at least the last 6 years. The diagnosis of Whipple's disease was confirmed by histopathological examination of duodenal biopsy samples with Periodic acid-Schiff positive macrophages and by polymerase chain reaction technique detecting the DNA of Tropheryma whipplei. The patient was commenced on several antimicrobials including beta-lactams and co-trimoxazole but she did not improve. Finally, after-long lasting i.v. tigecycline 100 mg BID she was commenced on p.o. doxycycline along with hydroxychloroquine 200 mg TID for one year and after by p.o. doxycycline alone. DISCUSSION: The intriguing thing with this case was not only the natural resistance to co-trimoxazole but that the infection was controlled empirically with long-lasting i.v. tigecycline since several failed attempts to discontinue i.v. treatment followed. This might be due to erratic absorption of oral drugs due to gut inflammation. CONCLUSIONS: To our knowledge, this is the first case of Whipple's disease successfully treated with long-lasting induction parenteral tigecycline followed by p.o. doxycycline along with hydroxychloroquine for one year and after by p.o. doxycycline alone. GERMS.
INTRODUCTION: Whipple's disease is a rare chronic infectious disease caused by Tropheryma whipplei. The infection mainly affects the small intestine of middle-aged patients, approximately three times more often in males than in females causing malabsorption and excessive weight loss but other organs may be affected as well. CASE REPORT: We describe a case of a 42-year-old woman with a history of chronic diarrhea and weight loss evolving for at least the last 6 years. The diagnosis of Whipple's disease was confirmed by histopathological examination of duodenal biopsy samples with Periodic acid-Schiff positive macrophages and by polymerase chain reaction technique detecting the DNA of Tropheryma whipplei. The patient was commenced on several antimicrobials including beta-lactams and co-trimoxazole but she did not improve. Finally, after-long lasting i.v. tigecycline 100 mg BID she was commenced on p.o. doxycycline along with hydroxychloroquine 200 mg TID for one year and after by p.o. doxycycline alone. DISCUSSION: The intriguing thing with this case was not only the natural resistance to co-trimoxazole but that the infection was controlled empirically with long-lasting i.v. tigecycline since several failed attempts to discontinue i.v. treatment followed. This might be due to erratic absorption of oral drugs due to gut inflammation. CONCLUSIONS: To our knowledge, this is the first case of Whipple's disease successfully treated with long-lasting induction parenteral tigecycline followed by p.o. doxycycline along with hydroxychloroquine for one year and after by p.o. doxycycline alone. GERMS.
Authors: René Mahnel; Anja Kalt; Sabine Ring; Andreas Stallmach; Warren Strober; Thomas Marth Journal: Am J Gastroenterol Date: 2005-05 Impact factor: 10.864
Authors: Gerhard E Feurle; Verena Moos; Katina Schinnerling; Anika Geelhaar; Kristina Allers; Federico Biagi; Hendrik Bläker; Annette Moter; Christoph Loddenkemper; Andreas Jansen; Thomas Schneider Journal: Ann Intern Med Date: 2010-12-07 Impact factor: 25.391