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

Highlights

• Prolonged unexplained fever and mesenteric lymphadenitis may reveal Whipple’s disease.

• Tropheryma whipplei-specific PCR is the first-line diagnostic tool.

• The detection of Tropheryma whipplei by specific PCR on target tissue is an efficient diagnostic tool for localized Whipple’s disease even in the absence of periodic acid–Schiff-positive inclusions on examination of biopsies.

Abstract

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.