Whipple's arthritis: Direct detection of Tropheryma whippelii in synovial fluid and tissue

• Published in: Arthritis and rheumatism 1999-04, Vol.42 (4), p.812-817
• Main Authors: O'Duffy, J. Desmond, Griffing, W. Leroy, Li, Chin‐Yang, Abdelmalek, Manal F., Persing, David H.
• Format: Article
• Language: English
• Subjects: Actinobacteria - genetics; Actinobacteria - isolation & purification; Adult; Arthritis, Reactive - microbiology; Biological and medical sciences; DNA, Bacterial - analysis; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Polymerase Chain Reaction; RNA, Bacterial - analysis; RNA, Ribosomal, 16S - analysis; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Synovial Fluid - microbiology; Synovial Membrane - microbiology; Whipple Disease - complications; Whipple Disease - diagnosis
• ISSN: 0004-3591; 1529-0131
• DOI: 10.1002/1529-0131(199904)42:4<812::AID-ANR27>3.0.CO;2-S

We describe 2 patients presenting with polyarthritis in whom the synovial fluid (1 patient) or synovial tissue (1 patient) was positive for Tropheryma whippelii, the Whipple's disease–associated bacillus, when examined by polymerase chain reaction (PCR) and DNA sequencing. Histopathologic findings were consistent with articular Whipple's disease in the synovial fluid of 1 patient and the synovial tissue of the other. In both patients, bowel mucosal specimens were negative for Whipple's disease features by histologic and PCR methods. One patient was positive for T whippelii in the peripheral blood. Control synovial fluid specimens from 40 patients with other arthritides, including Lyme arthritis, were negative. Sequencing of a 284‐basepair region of the 16S ribosomal RNA gene confirmed that the sequence is closely related to the known T whippelii sequence. Both patients responded to treatment with antibiotics.