{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T07:04:02Z","timestamp":1773299042409,"version":"3.50.1"},"reference-count":19,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,11,20]],"date-time":"2017-11-20T00:00:00Z","timestamp":1511136000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["APMIS"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:p>A 61\u2010year\u2010old woman received a diagnosis of undifferentiated non\u2010erosive arthritis in 2010 and assumed methotrexate and steroids in 2014. After 1 year, she experienced watery diarrhea, vomiting, fever, weight loss, and severe hypoalbuminemia, thus being admitted into our Unit. Esophagogastroduodenoscopy showed duodenal lymphangiectasia and duodenal biopsy samples several foamy <jats:styled-content style=\"fixed-case\">PAS<\/jats:styled-content>\u2010positive macrophages and villous subtotal atrophy. Transmission electron microscope demonstrated several extracellular and intracellular rod\u2010shaped bacteria (<jats:italic>Tropheryma whipplei<\/jats:italic>). Therefore, we diagnosed Whipple's disease. Our patient assumed doxycycline\/hydroxychloroquine with prompt remission of gastrointestinal symptoms. At 1 year of follow\u2010up, she was symptom\u2010free, histological reassessment showed almost complete mucosal healing and transmission electron microscope demonstrated bacteria breaking\/disappearance. The present report demonstrates that: (i) rheumatological manifestations are common onset symptoms of Whipple's disease; (ii) immunosuppressive therapy may delay the diagnosis and worsen clinical presentation; (iii) transmission electron microscopy for specific bacteria detection\/disappearance is an helpful diagnostic tool, when available.<\/jats:p>","DOI":"10.1111\/apm.12782","type":"journal-article","created":{"date-parts":[[2017,11,20]],"date-time":"2017-11-20T13:16:41Z","timestamp":1511183801000},"page":"92-96","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Transmission electron microscopy helpfulness in Whipple's disease masked by immunosuppressant therapy for arthritis"],"prefix":"10.1111","volume":"126","author":[{"given":"Alessandra","family":"Loiodice","sequence":"first","affiliation":[{"name":"Section of Gastroenterology Department of Emergency and Organ Transplantation University \u2018Aldo Moro\u2019 of Bari Bari Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Losurdo","sequence":"additional","affiliation":[{"name":"Section of Gastroenterology Department of Emergency and Organ Transplantation University \u2018Aldo Moro\u2019 of Bari Bari Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Iannone","sequence":"additional","affiliation":[{"name":"Section of Gastroenterology Department of Emergency and Organ Transplantation University \u2018Aldo Moro\u2019 of Bari Bari Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberta","family":"Rossi","sequence":"additional","affiliation":[{"name":"Section of Pathology Department of Emergency and Organ Transplantation University \u2018Aldo Moro\u2019 of Bari Bari Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Grazia","family":"Fiore","sequence":"additional","affiliation":[{"name":"Section of Pathology Department of Emergency and Organ Transplantation University \u2018Aldo Moro\u2019 of Bari Bari Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Domenico","family":"Piscitelli","sequence":"additional","affiliation":[{"name":"Section of Pathology Department of Emergency and Organ Transplantation University \u2018Aldo Moro\u2019 of Bari Bari Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,11,20]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/S1473-3099(15)00537-X","article-title":"Tropheryma Whipplei infection and Whipple's disease","volume":"16","author":"Marth T","year":"2016","journal-title":"Lancet Infect Dis"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0b013e3181f204a8"},{"key":"e_1_2_7_4_1","doi-asserted-by":"crossref","first-page":"e714","DOI":"10.1097\/MD.0000000000000714","article-title":"Gastrointestinal diagnosis of classical Whipple disease: clinical, endoscopic, and histopathologic features in 191 patient","volume":"94","author":"G\u00fcnther U","year":"2015","journal-title":"Medicine"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.130328"},{"key":"e_1_2_7_6_1","first-page":"1001","article-title":"Ultrastructure of Bacilli and the Bacillary origin of the macrophagic inclusions in Whipple's disease","volume":"131","author":"Silva MT","year":"1985","journal-title":"J Gen Microbiol"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkt310"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkr032"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(08)70042-2"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/03009740510015230"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2005.40128.x"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-126-7-199704010-00004"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1586\/14737159.1.3.299"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.48.3.747-752.2004"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1128\/IAI.70.3.1501-1506.2002"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.1202171"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2012.05.008"},{"key":"e_1_2_7_18_1","first-page":"380","article-title":"Lymphocytic duodenitis or microscopic enteritis and gluten\u2010related conditions: what needs to be explored?","volume":"30","author":"Ierardi E","year":"2017","journal-title":"Ann Gastroenterol"},{"key":"e_1_2_7_19_1","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1097\/00000478-198107000-00011","article-title":"Electron microscopy in the long term follow up of Whipple's disease. 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