You are here

Article Text

Article menu
Download PDFPDF
Case report
Granulomatous lung disease and immune reconstitution inflammatory syndrome in Whipple’s disease
  1. Patrick Hofmann1,2,
  2. Nina Durisch1,
  3. Claudia Buetikofer1 and
  4. Birgit Maria Helmchen3
  1. 1Internal Medicine, Hospital Uster, Uster, Switzerland
  2. 2Institute of Physiology, University of Zurich, Zurich, Switzerland
  3. 3Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
  1. Correspondence to Dr Patrick Hofmann; hofmannpatrick{at}bluewin.ch

Abstract

We present the case of a 70-year-old woman with a history of seronegative arthritis, recurrent pleural effusion and weight loss. A prior lung biopsy had revealed non-caseating epithelioid cell granulomas without evidence for microbial organisms on special stains. Intestinal biopsy findings where suspicious for Whipple’s disease, which was confirmed by PCR testing, both on the intestinal and retrospectively on the lung tissue. Treatment with ceftriaxone resulted in clinical deterioration with fever, arthritis and recurrent pleuritis consistent with immune reconstitution inflammatory syndrome. Dose increase of glucocorticoids and therapy rotation to doxycycline and hydroxychloroquine resulted in rapid clinical improvement.

  • stomach and duodenum
  • infectious diseases
  • pleural infection

https://doi.org/10.1136/bcr-2021-243633

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors PH: involved in patient care, design and drafting the manuscript. ND: involved in patient care, design, drafting and critical review of the manuscript. CB: involved in patient care, design, drafting and critical review of the manuscript. BMH: design, drafting and critical review of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.