Mesenteric lymphadenitis as a presenting feature of Whipple's disease

John Buchan's race through life, chased by his only foe-illness

This article examines John Buchan's experience of gastric illness, dyspepsia and duodenal ulcers within the medical context of his life during the first half of the twentieth century. In tracing some of the different and changing approaches to gastric illness over the intervening decades, it compares the medical knowledge and practices of that period with medical knowledge and treatment today. The article's low key empirical intersectional examination, too, touches on both ethics and justice. Its importance lies not only in its discussion on past and present medicine, but also in its scrutiny of Buchan's extraordinarily dutiful approach to his active and varied careers, often marred for him by sudden onsets of illness. Buchan's coping mechanisms, including mental and physical endurance, are spotlighted in his life and in some of his works, frequently written when he was in pain, or recuperating from illness. Both his fiction and non-fiction had multiple purposes: to support his extended family; to help his country; to help his fellow countrymen escape into adventure during war; and to help himself escape from pain.

Could CT abdomen and PET/CT be helpful in early diagnosis of Whipple's disease? A case report

Whipple’s disease is a rare disease, which can be fatal if not treated. It is often diagnosed at a late stage because of the varied disease presentation and its rare incidence. Classic Whipple’s disease presents with arthralgia, abdominal pain, diarrhea and weight loss. CT abdomen may show mesenteric lymphadenopathy with hypodense centers. These CT findings along with clinical presentation should prompt early diagnosis of Whipple’s disease. We present a case of classic Whipple’s disease with interesting CT abdomen and PET scan findings.

Whipple's Disease as the First Manifestation of Chronic Lymphocytic Leukaemia

Whipple’s disease is a rare multisystemic infectious disease that can mimic lymphoproliferative disorders and must be considered in the differential diagnosis of febrile syndromes. The authors describe the case of a 55-year-old man who presented to the Emergency Department with dyspnoea and abdominal pain. He had a 2-month history of fever, night sweats, asthenia and unintentional weight loss. Upon clinical examination he had bilateral inguinal lymphadenopathy. Blood tests showed iron-deficit anaemia and high C-reactive protein. Abdominal ultrasound showed mesenteric and iliac adenopathies and hepatosplenomegaly. The patient was admitted to the Internal Medicine department for additional testing. Flow cytometry analysis of peripheral blood showed CD5-positive monoclonal B-cell expansion. Excisional biopsy of a retroperitoneal adenopathy guided by computed tomography showed periodic acid–Schiff-positive bacilli inside the macrophages, further identified as Tropheryma whipplei through polymerase chain reaction. Bone marrow biopsy showed a scarce positive CD5 lymphoid population and haematopoietic alterations related to infection. The patient started treatment for T. whipplei with complete symptom resolution. This is the first case describing the simultaneous diagnosis of Whipple’s disease and chronic lymphocytic leukaemia in a patient with constitutional symptoms, fever and lymphadenopathies.

An atypical case of Whipple's disease presenting as fever of unknown origin: A brief review

A 59-year-old woman with epilepsy was admitted to hospital with a 6-year history of fever of unknown origin (FUO). Computed tomography (CT) showed extensive low-attenuation mesenteric and retroperitoneal lymphadenopathy. Investigations for malignancy and infection were negative, including two separate excisional biopsies of lymph nodes. An ascending aortic aneurysm was seen on CT, and a diagnosis of large vessel vasculitis (LVV) was considered. A trial of prednisone for presumed LVV was initiated and then discontinued when positron emission tomography (PET) failed to show vasculitis. Repeat core biopsy of a mesenteric lymph node revealed non-necrotizing granulomatous inflammation and histiocytes with periodic acid-Schiff (PAS)-positive intracellular material. Electron microscopy and polymerase chain reaction (PCR) of the tissue confirmed Tropheryma whipplei. She was treated with ceftriaxone for 2 weeks, followed by long-term combination doxycycline and hydroxychloroquine. The patient's seizure control improved on therapy, raising the suspicion that the seizure disorder was due to Whipple's disease.

Mesenteric lymphadenitis as a presenting feature of Whipple's disease: Value of PCR analysis

Whipple's disease (WD) is a rare chronic and systemic infection caused by the ubiquitous actinomycete Tropheryma whipplei. A case of localized infection with mesenteric adenopathy associated with a prolonged unexplained fever is reported herein. Screening by PCR on saliva and stool was positive, and T. whipplei was formally identified by specific PCR on duodenal and mesenteric adenopathy biopsies. Histological analysis did not demonstrate periodic acid-Schiff-positive macrophages or positive T. whipplei immunochemistry in either the duodenal mucosa or mesenteric nodes. Treatment with hydroxychloroquine and doxycycline allowed a rapid resolution of symptoms, and subsequent saliva and stool PCR results were negative.