Spondylodiscitis revealing Whipple disease.

Abstract

Whipple disease is a rare chronic infection caused by the Gram-positive intracellular bacterium Tropheryma whipplei. The classic clinical presentation includes digestive symptoms, weight loss, and polyarthralgia, with diagnosis requiring histological examination of duodenal biopsies and polymerase chain reaction (PCR). Localized forms of T. whipplei infection can significantly delay diagnosis. Spondylodiscitis is an extremely rare manifestation of Whipple disease with few cases reported in the literature. We present a case of subacute spondylodiscitis, assessed by MRI, in an 82-year-old patient with a previous history of seronegative rheumatoid arthritis unresponsive to treatment. Detection of the bacteria was confirmed through PCR on disco-vertebral biopsies while duodenal biopsies were normal. Symptoms rapidly improved with doxycycline and hydroxychloroquine treatment. This case highlights an atypical presentation of bone and joint manifestations in T. whipplei infection and the crucial role of specific PCR testing on biopsy material from affected tissues in the diagnostic process.