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Case Reports in Medicine
Volume 2018, Article ID 3417934, 4 pages
https://doi.org/10.1155/2018/3417934
Case Report

Isolated Knee Arthritis as Early and Only Symptom of Whipple’s Disease

1Servizio di Chirurgia e Ortopedia, Ospedale Regionale di Lugano, EOC, Ticino, Switzerland
2Servizio di Reumatologia, Ospedale Regionale di Lugano, EOC, Ticino, Switzerland

Correspondence should be addressed to Dario Giunchi; hc.coe@ihcnuig.oirad

Received 2 January 2018; Revised 18 April 2018; Accepted 7 May 2018; Published 27 May 2018

Academic Editor: David Grimaldi

Copyright © 2018 Dario Giunchi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We report a case of isolated Whipple’s disease involving the knee of a 64-year-old female patient who presented recurrent monoarthritis whose origin was not clear. Initially, the cause of the gradually invalidating symptoms was related to a meniscal lesion and a diffuse minor grade chondropathy, but pain and functional impairment suggested that more exams were needed. Biopsies were performed during arthroscopy. The histology showed highly inflammatory infiltrates with PAS staining negative for Tropheryma while PCR revealed the infection with Tropheryma whipplei. This, following the recommendation of a rheumatologist and infectious disease specialist, led to biopsies of the gastrointestinal tract and analysis of the cerebrospinal fluid that showed no other organ involvement. This confirms the scientific literature that an isolated monoarthritis without involvement of the gastrointestinal tract caused by this bacterium is rare but can occur as an early manifestation of potentially fatal systemic disease. Moreover, a review of the scientific literature showed the uncertainty about epidemiology of this rare disease, suggesting that more and specific data are required.