• Rev Med Interne · Nov 2021

    [Diagnostic issues of Whipple's disease during chronic inflammatory rheumatism: About three cases].

    • D Delarbre, L Gan, C Antoine, E Poisnel, A Cambon, F Dutasta, J F Paris, F Simon, and G Defuentes.
    • Service de médecine interne, Hôpital d'instruction des armées Sainte-Anne, 1, boulevard Sainte Anne, 83000 Toulon, France. Electronic address: david.delarbre@yahoo.fr.
    • Rev Med Interne. 2021 Nov 1; 42 (11): 801-804.

    IntroductionWhipple's disease (WD) can mimic chronic inflammatory rheumatism leading to incorrect prescription of tumor necrosis factor inhibitors (TNFI). Several complicated cases of WD have been reported during TNFI treatment which is strongly suspected to modify the host-pathogen relationship. Tropheryma whipplei asymptomatic carriage is high in the general population, making the diagnosis of WD more difficult face to unexplained arthritis.ObservationsWe report three observations that illustrate situations for which the detection of T. whipplei might be valuable to investigate the differential diagnosis of inflammatory rheumatism.ConclusionThe decision to check for T. whipplei infection should rely on individual clinical assessment. It should be considered in the absence of clinical response or in case of worsening of an inflammatory rheumatism under TNFI treatment, especially in front of atypical features. A systematic screening for T. whipplei before anti-TNF treatment seems unjustified since asymptomatic carriers are frequent.Copyright © 2021 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.

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