Source: Annual Congress 2006 - Sarcoidosis
Disease area: Interstitial lung diseases, Thoracic oncology

Abstract

A 56 year old man without medical history presented to the hospital in August 2003 with polyarthralgias, a truncal maculo-papular rash and axillary lymphnodes. Laboratory data suggested a mild inflammatory state (CRP of 28mg/L and VS of 40mn) and an elevated Angiotensin Converting Enzyme at 50IU/L. Thorax CT scan displayed enlarged mediastinal lymphnodes. A Skin and lymph node biopsy showed a non-caseating granulomatosis suggesting the diagnosis of sarcoidosis. A treatment by hydroxychloroquine was started.
In June 2005 a third degree atrio-ventricular block occured, leading to a pacemaker placement. A transthoracic echocardiogram demonstrated a dilated cardiomyopathy with a left venticular ejection fraction of 30% . Nuclear imaging of the myocardium was compatible with sarcoid myocarditis. Corticosteroids and Methotrexate were initiated.
Seven weeks later, an esophageo-gastroduodenoscopy, demonstrated an ulcerated duodeno-jejunitis. Duodenal biopsies showed a histiocytic infiltrate and a positive PAS stain. PCR assay for Tropheryma whippelii was positive leading to the diagnosis of Whipple‘s disease. PCR was also positive on the 2003 skin biopsies and lymph nodes.
This case report demonstrates the similarities in clinical presentation between systemic sarcoidosis and Whipple‘s disease and the critical value of specific Tropheryma whippelii PCR assay, that can be performed from archived paraffin pathologic blocks. In our knowledge, this is also the second published case of a Whipple disease complicated by a myocarditis.

Rating:

Share or cite this content

Citations should be made in the following way:
S. Lachkar, Y. Benhamou, F. Corne, H. Levesque, L. Thiberville (Rouen, France). A case of ²sarcoidosis like² Whipple‘s disease. Eur Respir J 2006; 28: Suppl. 50, 3136

Member's Comments

No comment yet.

Related content which might interest you: A rare case of oligometastatic disease Source: Virtual Congress 2020 – Lung cancer grand round Year: 2020 A rare manifestation of Behçet disease with pulmonary nodules: a case report Source: Annual Congress 2007 - Orphan diseases Year: 2007 Milroy‘s disease presenting as a rare case of chylothorax Source: Annual Congress 2009 - Interesting case reports and case series Year: 2009 Behcet disease and pulmonary tuberculosis association. A 4 cases report Source: Eur Respir J 2002; 20: Suppl. 38, 443s Year: 2002 Pulmonary tuberculosis and darier’s disease report of an unusual case Source: Eur Respir J 2004; 24: Suppl. 48, 421s Year: 2004 Botryotrichum infection in an adult patient with undiagnosed chronic granulomatous disease Source: International Congress 2016 – Severe respiratory infections in the intensive care unit and pleural and fungal infections Year: 2016 Familial case of Pott disease Source: Annual Congress 2008 - Difficult tuberculosis cases Year: 2008 Crohn's disease, perspective of another complex disease Source: Research Seminar 2009 - Post Genome Respiratory Epidemiology II - An interdisciplinary challenge Year: 2008 Two patients with the same type of iatrogenic disease Source: Eur Respir J 2005; 25: 389-391 Year: 2005 Lung-limited IgG4-related disease: A new form of IgG4-related disease? Source: Annual Congress 2012 - Diffuse parenchymal lung disease pathogenesis, biomarkers, therapy and new entities Year: 2012 A case of HIV-associated multicentric Castleman disease with pulmonary involvement Source: Annual Congress 2012 - Respiratory infections: a clinical point of view Year: 2012 A neurosarkoidosis case Source: Eur Respir J 2006; 28: Suppl. 50, 5s Year: 2006 Primary results from the STARLINER study of disease behaviour in suspected ILD Source: Virtual Congress 2020 – What is hot in idiopathic pulmonary fibrosis? Year: 2020 Pulmonary diseases in prisoner patients. A one year experience of the modes of diagnosis, incidence and reccurence of pulmonary diseases and their correlation with other diseases appearing in this diverse population Source: Eur Respir J 2006; 28: Suppl. 50, 700s Year: 2006 The comparison of sarcoidosis patients with benign and recurrent clinical course of the disease Source: Eur Respir J 2005; 26: Suppl. 49, 331s Year: 2005 A rare case of lithoptysis in a patient with Kartagener‘s syndrome Source: Annual Congress 2008 - Rare clinical cases Year: 2008 Hughes-Stovin syndrome: A case report Source: International Congress 2015 – Pulmonary circulation: pulmonary embolism and chronic thromboembolic pulmonary hypertension Year: 2015 Best case scenarios to prevent communicable diseases: the case of tuberculosis Source: ERS Summit on bridging the health divide in Europe 2012 Year: 2012 Sarcoidosis, a systemic disease Source: Annual Congress 2005 - Sarcoidosis: update on extrathoracic organ problems Year: 2005