[Whipple disease revealed by anti-TNFα therapy].

Abstract

INTRODUCTION:

Whipple disease is a rare infectious disease with protean clinical manifestations. This infection may mimic chronic inflammatory rheumatisms such as rheumatoid arthritis or spondylarthritis. In this context, introduction of a biotherapy after a diagnostic hesitation does not always lead to early complications. Sometimes, the clinical degradation follows an initial improvement, encouraging continuation of the immunosuppressive treatment and leading consequently to a greater diagnostic delay.

CASE REPORTS:

We report two cases of Whipple disease diagnosed in the context of an inflammatory disease with anti-TNFα failure. The first patient was a 53-year-old man who presented with an axial and peripheral spondylarthritis who was treated with etanercept and adalimumab. The second was a 42-year-old man who received adalimumab and then etanercept for a peripheral spondylarthritis.

CONCLUSION:

Whipple disease should be suspected in all patients who present with a chronic inflammatory rheumatism that is partially or not controlled with anti-TNFα therapy and who had persisting elevated acute phase reactants.

• Authors: L Sparsa, F Fenollar, L Gossec, J Leone, J-L Pennaforte, M Dougados, C Roux
• Journal: La Revue de medecine interne (Rev Med Interne) Vol. 34 Issue 2 Pg. 105-9 (Feb 2013) ISSN: 1768-3122 [Electronic] France
• Vernacular Title: Maladie de Whipple révélée par les traitements anti-TNFα
• PMID: 23199973 (Publication Type: Case Reports, English Abstract, Journal Article)
• Copyright: Copyright © 2012 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Humanized
• Tumor Necrosis Factor-alpha
• Adalimumab

Topics

• Adalimumab
• Adult
• Antibodies, Monoclonal (adverse effects, therapeutic use)
• Antibodies, Monoclonal, Humanized (adverse effects, therapeutic use)
• Diagnosis, Differential
• Humans
• Immunotherapy (adverse effects)
• Male
• Middle Aged
• Rheumatic Fever (therapy)
• Spondylarthropathies (therapy)
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)
• Whipple Disease (diagnosis)