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World J Cardiol. Dec 26, 2014; 6(12): 1278-1284
Published online Dec 26, 2014. doi: 10.4330/wjc.v6.i12.1278
Published online Dec 26, 2014. doi: 10.4330/wjc.v6.i12.1278
Complicated Whipple’s disease and endocarditis following tumor necrosis factor inhibitors
Thomas Marth, Division of Internal Medicine, Krankenhaus Maria Hilf, 54550 Daun, Germany
Author contributions: Marth T solely contributed to this manuscript.
Correspondence to: Thomas Marth, MD, Professor of Internal Medicine, Division of Internal Medicine, Krankenhaus Maria Hilf, Maria-Hilf-Straße 2, 54550 Daun, Germany. t.marth@krankenhaus-daun.de
Telephone: +49-6592-7152221 Fax: +49-6592-7152501
Received: July 30, 2014
Revised: September 2, 2014
Accepted: November 17, 2014
Published online: December 26, 2014
Processing time: 46 Days and 19.8 Hours
Revised: September 2, 2014
Accepted: November 17, 2014
Published online: December 26, 2014
Processing time: 46 Days and 19.8 Hours
Core Tip
Core tip: Arthritis frequently is the first symptom of Whipple’s disease (WD). Therefore, many patients are treated with anti-inflammatory drugs or tumor necrosis alpha inhibitors (TNFI) before diagnosis. As host immune defects contribute to the pathogenesis of WD, immunosuppressive therapy may deteriorate the course of Tropheryma whipplei (T. whipplei) infection. In this study, it is shown that treatment with TNFI is associated with severe complications of T. whipplei infection, particularly with endocarditis. TNFI therapy may lead to false negative periodic acid-Schiff-tests and thereby hinder the diagnosis of WD. T. whipplei infection should be considered in case of TNFI treatment failure.