inadvertant steroid tx of whipples disease misdxd as sarcoidosis

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Presse Med. 2005 Nov 19;34(20 Pt 1):1521-4. Related Articles, Links

[Whipple disease, initially diagnosed as sarcoidosis]

[Article in French]

Saba M, Rollot F, Park S, Grimaldi D, Sicard D, Abad S, Blanche P.

Service de medecine interne 2 du Pr D. Sicard, Universite Rene

Descartes, Hopital Cochin, Paris. sabamona@...

INTRODUCTION: Whipple disease is a multisystem infectious disease

caused by Tropheryma whipplei. We report a case in which an initial

diagnosis of sarcoidosis was changed to Whipple disease

endocarditis. CASE: Based on clinical, radiographic, endoscopic and

histologic findings, this 61-year-old man was diagnosed with

sarcoidosis. Initial response to corticotherapy was good, but the

patient required 35 mg of prednisone daily. The subsequent onset of

clinical and laboratory signs of inflammation cast doubt on the

diagnosis. After cardiac ultrasound revealed a mass 1 cm in diameter

on the mitral valve, apparently vegetation, we diagnosed culture-

negative infective endocarditis and ruled out most possible causes.

PCR of a duodenal biopsy sample showed Tropheryma whipplei, thus

confirming the diagnosis of Whipple disease, despite normal

histological findings. After 3 weeks of intravenous gentamicin and

amoxicillin treatment, oral cotrimoxazole was substituted. Follow-up

transesophageal ultrasound showed no mitral vegetation. The patient,

still under cotrimoxazole, has been off prednisone for 13 months and

is completely asymptomatic. CONCLUSION: This case is an illustration

of the difficulty in distinguishing Whipple disease from sarcoidosis

in practice and of the importance of that distinction.

Publication Types:

Case Reports

PMID: 16301965 [PubMed - indexed for MEDLINE