Whipple's Disease as the First Manifestation of Chronic Lymphocytic Leukaemia

  • Verónica Botelho Guiomar Internal Medicine Department, Centro Hospitalar de São João, Porto, Portugal
  • Maria João Pinto Internal Medicine Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
  • Clara Gomes Internal Medicine Department, Centro Hospitalar de São João, Porto, Portugal
  • Cristina Correia Internal Medicine Department, Centro Hospitalar de São João, Porto, Portugal
  • Sofia Tavares Internal Medicine Department, Centro Hospitalar de São João, Porto, Portugal
  • Vanessa Chaves Internal Medicine Department, Centro Hospitalar de São João, Porto, Portugal
  • Diana Oliveira Internal Medicine Department, Centro Hospitalar de São João, Porto, Portugal

Keywords

Fever, lymphadenopathy, Whipple's disease, chronic lymphocytic leukaemia, small lymphocytic lymphoma

Abstract

Whipple's disease is a rare multisystemic infectious disease that can mimic lymphoproliferative disorders and must be considered in the differential diagnosis of febrile syndromes. The authors describe the case of a 55-year-old man who presented to the Emergency Department with dyspnoea and abdominal pain. He had a 2-month history of fever, night sweats, asthenia and unintentional weight loss. Upon clinical examination he had bilateral inguinal lymphadenopathy. Blood tests showed iron-deficit anaemia and high C-reactive protein. Abdominal ultrasound showed mesenteric and iliac adenopathies and hepatosplenomegaly. The patient was admitted to the Internal Medicine department for additional testing. Flow cytometry analysis of peripheral blood showed CD5-positive monoclonal B-cell expansion. Excisional biopsy of a retroperitoneal adenopathy guided by computed tomography showed periodic acid–Schiff-positive bacilli inside the macrophages, further identified as Tropheryma whipplei through polymerase chain reaction. Bone marrow biopsy showed a scarce positive CD5 lymphoid population and haematopoietic alterations related to infection. The patient started treatment for T. whipplei with complete symptom resolution. This is the first case describing the simultaneous diagnosis of Whipple's disease and chronic lymphocytic leukaemia in a patient with constitutional symptoms, fever and lymphadenopathies.

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  • Published: 2019-09-25

    Issue: Vol 6 No 10 (view)

    Section: Articles

    How to cite:
    Guiomar, V., Pinto, M. J., Gomes, C., Correia, C., Tavares, S., Chaves, V., & Oliveira, D. (2019). Whipple’s Disease as the First Manifestation of Chronic Lymphocytic Leukaemia. European Journal of Case Reports in Internal Medicine, 6(10). https://doi.org/https://doi.org/10.12890/2019_001270