Abstract
Whipple's disease (WD) is a rare infection caused by the bacterium Tropheryma whipplei that can affect multiple organs and most commonly occurs in the immunocompetent host. Only 3 cases of WD have been reported in the setting of immunosuppression for organ transplantation. Here, we report the first case of WD, to our knowledge, in a patient after liver transplantation with comorbid graft-versus-host-disease. We discuss the diagnostic challenges in this setting and the value of electron microscopy and in situ hybridization methods for confirming the infection. WD may be under-diagnosed in immunosuppressed transplant patients because the disease can present with atypical clinical and histological features that suggest other conditions.
Keywords:
Tropheryma whipplei; Whipple's disease; gastroenterology; graft-versus-host disease; hepatology; immunosuppression; liver transplantation.
© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
MeSH terms
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Adrenal Cortex Hormones / adverse effects
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Adrenal Cortex Hormones / therapeutic use
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Aged
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Anti-Bacterial Agents / administration & dosage
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Anti-Bacterial Agents / therapeutic use*
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Biopsy
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Carcinoma, Hepatocellular / surgery
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Diarrhea / drug therapy
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Diarrhea / microbiology*
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Diarrhea / pathology
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Endoscopy, Gastrointestinal
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Fatal Outcome
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Graft vs Host Disease / drug therapy
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Graft vs Host Disease / pathology
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Humans
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Immunosuppression Therapy / adverse effects*
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Immunosuppression Therapy / methods
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Immunosuppressive Agents / adverse effects
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Immunosuppressive Agents / therapeutic use
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In Situ Hybridization, Fluorescence
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Intestinal Mucosa / pathology
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Liver Transplantation / adverse effects*
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Male
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Microscopy, Electron
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Pancytopenia / blood
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Pancytopenia / etiology
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Tropheryma / isolation & purification*
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Tropheryma / ultrastructure
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Whipple Disease / blood
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Whipple Disease / drug therapy
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Whipple Disease / microbiology*
Substances
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Adrenal Cortex Hormones
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Anti-Bacterial Agents
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Immunosuppressive Agents