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KMID : 0988920210190010119
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Intestinal Research
2021 Volume.19 No. 1 p.119 ~ p.125
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Whipple disease mimicking inflammatory bowel disease
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Tatsuki Maiko
Ishige Takashi
Igarashi Yoshiko
Hatori Reiko
Hokama Akira
Hirato Junko
Muise Aleixo
Takizawa Takumi
Arakawa Hirokazu
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Abstract
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Whipple disease is a systemic chronic infection caused by Tropheryma whipplei. Although chronic diarrhea is a common gastrointestinal symptom, diagnosis is often difficult because there are no specific endoscopic findings, and the pathogen is not detectable by stool culture. We present a female patient with Whipple disease who developed chronic bloody diarrhea and growth retardation at the age of 4 years. Colonoscopy showed a mildly edematous terminal ileum and marked erythema without vascular patterns throughout the sigmoid colon and rectum. Subsequently, a primary diagnosis of ulcerative colitis was made. Histopathological analysis of the terminal ileum showed the presence of foamy macrophages filled with periodic acid-Schiff-positive particles. Polymerase chain reaction using DNA from a terminal ileum biopsy sample amplified a fragment of 16S rRNA from T. whipplei. Antibiotic treatment relieved the patient’s symptoms. There was no evidence of immunodeficiency in the present case. Since Whipple disease worsens after anti-tumor necrosis factor inhibitor therapy, considering this infection in the differential diagnosis may be important in patients with inflammatory bowel disease, especially before initiation of immunotherapy.
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KEYWORD
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Tropheryma whipplei, Colitis, ulcerative, Child, preschool
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