{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T14:51:17Z","timestamp":1764168677898,"version":"3.46.0"},"reference-count":18,"publisher":"Georg Thieme Verlag KG","issue":"08","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Z Gastroenterol"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Background Risk factors for the development of Whipple's disease\n      (WD) are largely unknown. Case reports, case series, and reviews suggest immunosuppressive\n      therapy as a potential triggering factor in WD. The low incidence of WD and non-specific\n      symptoms at disease onset contribute to the frequent delay of diagnosis. We describe our\n      centre\u00b4s experience on differences in the clinical presentation of patients with classic WD\n      compared to patients with \u201cmasked\u201d WD because of immunosuppressive therapy.<\/jats:p>\n                  <jats:p>Methods In this retrospective case series, 8 patients were\n      included. Diagnosis of WD was confirmed by histological staining of duodenal biopsies\n      revealing T. whipplei within foamy macrophages or by PCR- based\n      detection of specific T. whipplei DNA. Clinical manifestations,\n      laboratory data, and medication have been recorded over a period of 19 years. Subgroup\n      analyses for the two different variants of WD were performed.<\/jats:p>\n                  <jats:p>Results Seven of eight patients were initially diagnosed with\n      rheumatic disease (polyarthritis, polymyalgia rheumatica). One patient was correctly diagnosed\n      at the beginning without any medication. Three patients were on immunosuppressive therapy and\n      being treated with disease-modifying drugs (DMARDs), three patients were receiving low-dose\n      cortisone in combination with non-steroidal anti- inflammatory drugs (NSAIDs), and one patient\n      was receiving NSAIDs only. All patients presented with increased parameters of inflammation\n      and with clinical and\/or laboratory signs of a malabsorption. From the onset of first\n      symptoms, diagnosis of WD took a median of 36 months (range: 6\u2013120 months). The time between\n      onset of joint complaints and onset of gastrointestinal symptoms was 36 months (range: 0\u2013117\n      months). WD patients receiving immunosuppressive therapy, compared to those not receiving it,\n      had a longer duration of gastrointestinal symptoms (12 months versus 6 months) and reported a\n      greater weight loss (20,3 kg versus 7,8 kg) up to diagnosis of WD.<\/jats:p>\n                  <jats:p>Conclusions Immunosuppressive drugs may delay the diagnosis of WD\n      and prolong the course of T. whipplei infection with deterioration\n      of clinical symptoms. If a patient with rheumatic complaints develops gastrointestinal\n      symptoms, diagnosis of WD should be considered and proper diagnostic investigation carried\n      out.<\/jats:p>","DOI":"10.1055\/a-1890-5878","type":"journal-article","created":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T19:58:36Z","timestamp":1679687916000},"page":"1002-1008","source":"Crossref","is-referenced-by-count":1,"title":["Whipple\u2019s Disease \u2013 delay of diagnosis by immunosuppressive therapy; a case-series report"],"prefix":"10.1055","volume":"61","author":[{"given":"Wilfried","family":"Obst","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Infectious Diseases, Otto von Guericke Universit\u00e4t Magdeburg, Magdeburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Armin","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jochen","family":"Weigt","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Infectious Diseases, Otto von Guericke Universit\u00e4t Magdeburg, Magdeburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Canbay","sequence":"additional","affiliation":[{"name":"Department of Medicine, Ruhr University Bochum, Bochum, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Malfertheiner","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Infectious Diseases, Otto von Guericke Universit\u00e4t Magdeburg, Magdeburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrike von","family":"Arnim","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Infectious diseases, Otto von Guericke Universit\u00e4t Magdeburg, Magdeburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,3,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1016\/0140-6736(91)90545-z","article-title":"Phylogeny of the Whipple's-disease- associated bacterium","volume":"338","author":"KH Wilson","year":"1991","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1056\/NEJM199207303270501","article-title":"Identification of the uncultured bacillus of Whipple's disease","volume":"327","author":"DA Relman","year":"1992","journal-title":"N Engl J Med"},{"key":"ref3","first-page":"167","article-title":"Whipple's Disease","volume":"30","author":"W Obst","year":"2014","journal-title":"Viszeralmedizin"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e13","DOI":"10.1016\/S1473-3099(15)00537-X","article-title":"Tropheryma whipplei infection and Whipple's disease","volume":"16","author":"T Marth","year":"2016","journal-title":"Lancet Infect Dis"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1097\/MD.0b013e3181f204a8","article-title":"Systemic Tropheryma whipplei: clinical presentation of 142 patients with\n          infections diagnosed or confirmed in a reference center","volume":"89","author":"J-C Lagier","year":"2010","journal-title":"Medicine (Baltimore)"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1097\/00005792-199705000-00003","article-title":"Whipple disease. 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