Case Report

Multisegmental spondylitis due to Tropheryma whipplei: Case report

David Spoerl , Diego Bär , Julian Cooper , Thomas Vogt , Alan Tyndall and Ulrich A Walker

Department of Rheumatology, University of Basel, Felix Platter Spital, Basel, Switzerland

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Orphanet Journal of Rare Diseases 2009, 4:13doi:10.1186/1750-1172-4-13

Published:	3 June 2009

Abstract

We report a patient who presented with inflammatory back pain due to multisegmental spondylitis. Following a vertebral biopsy which failed to detect an infectious organism, the patient was treated with etanercept, a tumor necrosis factor (TNF)-α inhibitor, for suspected undifferentiated spondyloarthritis. The back pain worsened and the spondylitic lesions increased. Only in a vertebral rebiopsy with polymerase chain reaction (PCR) amplification of Tropheryma whipplei, the causative agent of Whipple's disease was identified. Tropheryma whipplei should be considered as a cause of spondylitis even with multisegmental involvement and in the absence of gastrointestinal symptoms. In this clinical setting, routine PCR for Tropheryma whipplei from vertebral biopsies is recommended.