|Beitragstitel||Isolated knee arthritis as early and only symptom of Whipple’s disease: a case report|
The clinical diagnosis of the Whipple's disease, a rare bacterial infection, due to the wide variability of manifestations, is very difficult. It may involve any organ system in the body. The gastrointestinal tract is the most frequently involved organ. Other manifestations include low-grade fever, lymphadenopathy, skin hyperpigmentation, endocarditis, pleuritis, seronegative arthritis, uveitis, spondylodiscitis, and neurological manifestations, and these signs may occur in the absence of gastrointestinal manifestations. Recently, in 2001, the Whipple bacteria have been characterized at the molecular level. Phylogenetic analysis of these sequences revealed a new bacterial species related to the actinomycete branch which was named “Tropheryma whippelli.” However, “T. whippelii” DNA has also been found in persons without clinical and histological evidence of Whipple's disease.
We report a case of focal Whipple’s disease involving the knee of a 64 years old female patient who presented recurrent monoarthritis whose origin was not clear. Initially the cause of the gradually invalidating symptoms was related to a meniscal lesion and a diffuse minor grade chondropathy. The discrepancy between the suspected aetiology and the clinical setting (pain and functional impairment) suggested that more exams were needed. Biopsies performed at first arthroscopy revealed the infection of Tropheryma Whipplei. This, following recommendation of rheumatologist and infectious disease specialist, led to biopsies of the gastro intestinal tract and analysis of the cerebrospinal fluid that showed no involvement a part from the knee. No evidence of a systemic infection could be found after all the investigations.
The literature review confirms that an isolated monoarthritis without involvement of the gastrointestinal tract caused by this bacterium is rare but nowadays is often described as an early manifestation of the disease. Moreover, the uncertainty about epidemiology of this rare disease suggests that more and specific data are required.