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Infectious Diseases
Classic Whipple disease presenting as genuine pyrexia of unknown origin following immunosuppression with adalimumab
  1. Mustafa Al-Musawi1,
  2. Andrew Hughes2,
  3. Shoa Ali Zafir3 and
  4. Hannah Rose4
  1. 1General Medicine, Barwon Health, Geelong, Victoria, Australia
  2. 2Infectious Diseases, Barwon Health, Geelong, Victoria, Australia
  3. 3Pathology, Australian Clinical Labs, Geelong, Victoria, Australia
  4. 4Haematology, Barwon Health, Geelong, Victoria, Australia
  1. Correspondence to Dr Mustafa Al-Musawi; mustafa.al-musawi{at}barwonhealth.org.au

Abstract

Whipple disease (WD) is a rare chronic multisystem infectious disorder caused by the bacterium Tropheryma whipplei (T. whipplei) and is more prevalent than previously thought. Its diagnosis is often delayed by months to years owing to its rarity, non-specific manifestations and insidious course. WD classically presents with polyarthropathy followed months to years later by the development of gastrointestinal symptoms, which often lead to the diagnosis. Pyrexia of unknown origin (PUO) without gastrointestinal involvement is an extremely rare presentation. We describe a case of WD presenting as genuine PUO following immunosuppression with the tumour necrosis factor-alpha monoclonal antibody adalimumab for seronegative polyarthropathy.

  • Infectious diseases
  • Infection (gastroenterology)
  • Malabsorption
  • Bone and joint infections
  • Musculoskeletal syndromes

https://doi.org/10.1136/bcr-2024-261968

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: MA-M, AH, HR and SAZ. The following authors gave final approval of the manuscript: MA-M, AH, HR and SAZ.

    • 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.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

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