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

Table 4 Lack of reliability of standard diagnostic procedures in patient group I: Different situations ("settings") of the diagnostic procedures

Setting	Diagnostic procedurefor suspected WDbefore TNFI therapy	Diagnostic procedurefor suspected WDafter TNFI therapy	Patients (n) (reference)
1	Duodenal biopsy PAS neg	Duodenal biopsy PAS neg PCR pos	3 [19,21,25]
2	Duodenal biopsy PAS neg	Duodenal/small bowel biopsy PAS pos (PCR not performed )	3 [19,20,25]
3	“Duodenal mucosa normal“	Duodenal/jejunal PAS pos PCR pos	1 [23]
4	Duodenal biopsy PAS neg	Explanted heart valve PCR pos	1 [13]
5	Duodenal biopsy PAS neg PCR neg	Explanted heart valve PCR pos	1 [15]
6	None performed	Duodenal biopsy PAS pos PCR pos	3 [17,24,26]
7	None performed	Duodenal biopsy PAS neg PCR pos	2 [12,27]
8	None performed	Colonic biopsy PAS pos Stool, blood, CSF PCR pos	1 [18]
Total	9/9 PAS negative or mucosa normal	5/13 intestinal biopsies PAS neg	15 patients,
	1/1 PCR negative	8/13 intestinal biopsies PAS pos 10/10 intestinal PCR pos	13 reports

PAS: Periodic acid-Schiff staining; PCR: Polymerase chain reaction; TFNI: Tumor necrosis factor alpha inhibitor; WD: Whipple’s disease. Details are not stated in 23 patients (references 14, 16, 22, 28-30). neg: Negative; pos: Positive.