Seronegative Arthritis and Whipple Disease: Risk of Misdiagnosis in the Era of Biologic Agents.
Journal
Case reports in rheumatology
ISSN: 2090-6889
Titre abrégé: Case Rep Rheumatol
Pays: United States
ID NLM: 101585353
Informations de publication
Date de publication:
2019
2019
Historique:
received:
09
07
2019
revised:
06
09
2019
accepted:
11
09
2019
entrez:
19
11
2019
pubmed:
19
11
2019
medline:
19
11
2019
Statut:
epublish
Résumé
We report 2 cases of Whipple disease (WD), previously diagnosed as seronegative polyarthritis and treated for several years with immunosuppressive agents, accordingly. Both cases had been treated over years with cDMARDs and bDMARDs. The first patient was a 48-year-old male, who developed a life-threatening disease characterized by fever, significant weight loss, and bloody diarrhoea, supported with RBC transfusions. The second patient was a 55-year-old man, presenting with arthritis, fever, serositis, lymphadenopathy, thoracic rash, and systemic inflammation; at the beginning he was diagnosed as adult onset Still's disease. He was treated with steroids and antitumour necrosis factor agents, but showed no improvement. Both patients were eventually treated with antimicrobial therapy for WD with dramatic improvement and no clinical relapse in 6 months. This paper reviews the literature on WD mimicking chronic inflammatory arthritis. WD may lead to chronic seronegative arthritis that might often be misrecognized. Importantly, patients treated with bDMARDs and glucocorticoids might develop a life-threatening disease. Therefore, WD should be suspected and excluded in patients showing resistance or frequent recurrence of chronic arthritis, if seronegative, under treatment with bDMARDs, especially in the presence of new, unexpected sign and/or symptoms.
Identifiants
pubmed: 31737398
doi: 10.1155/2019/3410468
pmc: PMC6815603
doi:
Types de publication
Case Reports
Langues
eng
Pagination
3410468Informations de copyright
Copyright © 2019 Luca Quartuccio et al.
Déclaration de conflit d'intérêts
The authors declare that there are no conflicts of interest regarding the publication of this paper.
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