Complicated Whipple’s disease and endocarditis following tumor necrosis factor inhibitors

Table 1 Frequency of the symptoms at the time of diagnosis of Whipple’s disease

	Patient group I	Patient group II	Patientgroup III
Patients (n)	41	61	1059
Therapy with TNFI	+	-	-
Therapy with non- biological DMARD	+	+	-
Signs or symptoms
Arthritis	85.4%	88.5%	70%-90%
Fever	53.6%	44.3%	35%-60%
Weight loss	36.6%	42.6%	80%-96%
Diarrhea	35.3%	54.1%	70%-85%
Endocarditis	12.2%	1.6%b	0.16%b
Pericarditis	12.2%	3.3%	0.08%b
IRIS	16%	22.9%	0%

All patients treated with non-biological disease modifying anti-rheumatic drugs (DMARDs) or tumor necrosis factor alpha inhibitor (TNFI) had experienced arthropathy or arthritis before the start of the therapy. In patient group III, few patients were treated with non-biological DMARDs (mostly steroids), but none were treated with TNFI. In 16 patients (reference 22), some symptoms (neurologic or eye symptoms) are not explicitly stated. The percentage of neurologic or eye symptoms of the analyzed patients were comparable (20% in group I (n = 25), 21.3% in group II (n = 45), and 10%-25% in group III).

^bP < 0.01 vs group I. IRIS: Immune reconstitution inflammatory syndrome.