Tropheryma whipplei infection (Whipple's disease) in a patient after liver transplantation

S M Vindigni, J Taylor, L A S Quilter, T S Hyun, C Liu, S L Rosinski, R M Rakita, D N Fredricks, C J Damman
Transplant Infectious Disease: An Official Journal of the Transplantation Society 2016, 18 (4): 617-24
Whipple's disease (WD) is a rare infection caused by the bacterium Tropheryma whipplei that can affect multiple organs and most commonly occurs in the immunocompetent host. Only 3 cases of WD have been reported in the setting of immunosuppression for organ transplantation. Here, we report the first case of WD, to our knowledge, in a patient after liver transplantation with comorbid graft-versus-host-disease. We discuss the diagnostic challenges in this setting and the value of electron microscopy and in situ hybridization methods for confirming the infection. WD may be under-diagnosed in immunosuppressed transplant patients because the disease can present with atypical clinical and histological features that suggest other conditions.

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