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

Arthritis Rheum. 1999 Apr;42(4):812-7. doi: 10.1002/1529-0131(199904)42:4<812::AID-ANR27>3.0.CO;2-S.

Abstract

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.

Publication types

  • Case Reports

MeSH terms

  • Actinobacteria / genetics
  • Actinobacteria / isolation & purification
  • Adult
  • Arthritis, Reactive / microbiology*
  • DNA, Bacterial / analysis
  • Humans
  • Male
  • Middle Aged
  • Polymerase Chain Reaction
  • RNA, Bacterial / analysis
  • RNA, Ribosomal, 16S / analysis
  • Synovial Fluid / microbiology*
  • Synovial Membrane / microbiology*
  • Whipple Disease / complications*
  • Whipple Disease / diagnosis*

Substances

  • DNA, Bacterial
  • RNA, Bacterial
  • RNA, Ribosomal, 16S