{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T13:24:38Z","timestamp":1770470678808,"version":"3.49.0"},"reference-count":62,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"12","license":[{"start":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T00:00:00Z","timestamp":1742774400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,3,24]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>\n                      Whipple\u2019s disease is a rare chronic infectious disorder caused by the bacterium\n                      <jats:italic>Tropheryma whipplei.<\/jats:italic>\n                      It commonly involves the small intestine and presents with chronic diarrhea, abdominal pain, weight loss, enlarged lymph nodes, and migratory polyarthralgia, with involvement of the CNS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>\n                      The authors describe the case of a 69-year-old male who presented with arthritis on immunomodulatory treatment, weight loss, confusion, worsening memory, and right-sided weakness. MRI of the brain revealed a 2.4-cm enhancing mass in the left lentiform nucleus. A stereotactic biopsy was performed, with pathology demonstrating granulomatous inflammation with reactive astrocytes. Broad-range polymerase chain reaction and next-generation sequencing of the tissue detected\n                      <jats:italic>T. whipplei<\/jats:italic>\n                      DNA. Intravenous ceftriaxone yielded no clinical improvement.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>\n                      Whipple\u2019s disease should be considered in an immunosuppressed patient presenting with progressive cognitive decline, weight loss, and imaging findings that are atypical for a neoplasm\n                      <jats:italic>.<\/jats:italic>\n                      Whipple\u2019s disease can be diagnosed by histological identification of the organism or by the presence of foamy macrophages containing gram-positive bacilli in the biopsy of the small intestine or affected tissues. Its diagnosis can be challenging as\n                      <jats:italic>T. whipplei<\/jats:italic>\n                      grows inconsistently in culture and can rapidly become undetectable with antibiotic therapy. Molecular detection might be required to improve diagnostic accuracy.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE24687\">https:\/\/thejns.org\/doi\/10.3171\/CASE24687<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case24687","type":"journal-article","created":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T16:33:08Z","timestamp":1742920388000},"source":"Crossref","is-referenced-by-count":1,"title":["Molecular detection of Tropheryma whipplei DNA: a crucial tool for diagnosing Whipple\u2019s disease in the brain. Illustrative case"],"prefix":"10.3171","volume":"9","author":[{"given":"Saltanat","family":"Ualiyeva","sequence":"first","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atreyee","family":"Basu","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie","family":"Roguski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H. Berk","family":"Degirmenci","sequence":"additional","affiliation":[{"name":"Section of Rheumatology, Boston University Medical Center, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maureen","family":"Dubreuil","sequence":"additional","affiliation":[{"name":"Section of Rheumatology, Boston University Medical Center, Boston, Massachusetts"},{"name":"Veterans Affairs Boston Healthcare System, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel M.","family":"Erdil","sequence":"additional","affiliation":[{"name":"Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9266-0887","authenticated-orcid":true,"given":"Lilit","family":"Garibyan","sequence":"additional","affiliation":[{"name":"Wellman Center for Photomedicine, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Knarik","family":"Arkun","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts"},{"name":"Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"bib1","series-title":"StatPearls","article-title":"Whipple disease","author":"Antunes","year":"2023","unstructured":"Antunes CSinghal M.Whipple disease. In: StatPearls. StatPearls Publishing; 2023. Accessed December 8, 2023. http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK441937\/."},{"issue":"2","key":"bib2","series-title":"Clin Microbiol Rev","first-page":"529","article-title":"Clinical manifestations, treatment, and diagnosis of Tropheryma whipplei infections","volume":"30","author":"Dolmans","year":"2017","unstructured":"Dolmans RAVBoel CHELacle MMKusters JG.Clinical manifestations, treatment, and diagnosis of Tropheryma whipplei infections. Clin Microbiol Rev. 2017;30(2):529-555."},{"issue":"7","key":"bib3","series-title":"Am J Surg Pathol","first-page":"1066","article-title":"Whipple disease a century after the initial description: increased recognition of unusual presentations, autoimmune comorbidities, and therapy effects","volume":"36","author":"Arnold","year":"2012","unstructured":"Arnold CAMoreira RKLam-Himlin DDe Petris GMontgomery E.Whipple disease a century after the initial description: increased recognition of unusual presentations, autoimmune comorbidities, and therapy effects. Am J Surg Pathol. 2012;36(7):1066-1073."},{"issue":"5","key":"bib4","series-title":"Med (Baltim)","first-page":"337","article-title":"Systemic Tropheryma whipplei: clinical presentation of 142 patients with infections diagnosed or confirmed in a reference center","volume":"89","author":"Lagier","year":"2010","unstructured":"Lagier JCLepidi HRaoult DFenollar F.Systemic Tropheryma whipplei: clinical presentation of 142 patients with infections diagnosed or confirmed in a reference center. Med (Baltim). 2010;89(5):337-345."},{"issue":"3","key":"bib5","series-title":"Lancet Infect Dis","first-page":"e13","article-title":"Tropheryma whipplei infection and Whipple\u2019s disease","volume":"16","author":"Marth","year":"2016","unstructured":"Marth TMoos VM\u00fcller CBiagi FSchneider T.Tropheryma whipplei infection and Whipple\u2019s disease. Lancet Infect Dis. 2016;16(3):e13-e22."},{"issue":"1","key":"bib6","series-title":"N Engl J Med","first-page":"55","article-title":"Whipple\u2019s disease","volume":"356","author":"Fenollar","year":"2007","unstructured":"Fenollar FPu\u00e9chal XRaoult D.Whipple\u2019s disease. N Engl J Med. 2007;356(1):55-66."},{"issue":"9185","key":"bib7","series-title":"Lancet","first-page":"1178","article-title":"Tropheryma whippelii DNA in saliva of healthy people","volume":"354","author":"Street","year":"1999","unstructured":"Street SDonoghue HDNeild GH.Tropheryma whippelii DNA in saliva of healthy people. Lancet. 1999;354(9185):1178-1179."},{"issue":"12","key":"bib8","series-title":"PLOS Negl Trop Dis","first-page":"e1403","article-title":"Tropheryma whipplei: a common bacterium in rural Senegal","volume":"5","author":"Keita","year":"2011","unstructured":"Keita AKBassene HTall ATropheryma whipplei: a common bacterium in rural Senegal. PLOS Negl Trop Dis. 2011;5(12):e1403."},{"issue":"2","key":"bib9","series-title":"Int J Colorectal Dis","first-page":"114","article-title":"Decreased levels of interleukin-12p40 in the serum of patients with Whipple\u2019s disease","volume":"21","author":"Kalt","year":"2006","unstructured":"Kalt ASchneider TRing SDecreased levels of interleukin-12p40 in the serum of patients with Whipple\u2019s disease. Int J Colorectal Dis. 2006;21(2):114-120."},{"issue":"2","key":"bib10","series-title":"Gastroenterology","first-page":"442","article-title":"Defects of monocyte interleukin 12 production and humoral immunity in Whipple\u2019s disease","volume":"113","author":"Marth","year":"1997","unstructured":"Marth TNeurath MCuccherini BAStrober W.Defects of monocyte interleukin 12 production and humoral immunity in Whipple\u2019s disease. Gastroenterology. 1997;113(2):442-448."},{"issue":"5","key":"bib11","series-title":"Gastroenterology","first-page":"1468","article-title":"Dysregulated peripheral and mucosal Th1\/Th2 response in Whipple\u2019s disease","volume":"123","author":"Marth","year":"2002","unstructured":"Marth TKleen NStallmach ADysregulated peripheral and mucosal Th1\/Th2 response in Whipple\u2019s disease. Gastroenterology. 2002;123(5):1468-1477."},{"issue":"1","key":"bib12","series-title":"Curr Opin Rheumatol","article-title":"Whipple disease and arthritis","volume":"13","author":"Pu\u00e9chal","year":"2001","unstructured":"Pu\u00e9chal X.Whipple disease and arthritis. Curr Opin Rheumatol. 2001;13(1):74-79."},{"issue":"1","key":"bib13","series-title":"J R Soc Med","first-page":"10","article-title":"The ramifications of HLA-B27","volume":"97","author":"Sheehan","year":"2004","unstructured":"Sheehan NJ.The ramifications of HLA-B27. J R Soc Med. 2004;97(1):10-14."},{"issue":"8441","key":"bib14","series-title":"Lancet","article-title":"Association of Whipple\u2019s disease with HLA-B27","volume":"1","author":"Feurle","year":"1985","unstructured":"Feurle GE.Association of Whipple\u2019s disease with HLA-B27. Lancet. 1985;1(8441):1336."},{"issue":"3","key":"bib15","series-title":"Dig Dis Sci","first-page":"247","article-title":"Is there an immune deficit in Whipple\u2019s disease?","volume":"26","author":"Dobbins","year":"1981","unstructured":"Dobbins WO.Is there an immune deficit in Whipple\u2019s disease? Dig Dis Sci. 1981;26(3):247-252."},{"issue":"1","key":"bib16","series-title":"Dig Dis Sci","first-page":"213","article-title":"Tropheryma whipplei infection (Whipple disease) in the USA","volume":"64","author":"Hujoel","year":"2019","unstructured":"Hujoel IAJohnson DHLebwohl BTropheryma whipplei infection (Whipple disease) in the USA. Dig Dis Sci. 2019;64(1):213-223."},{"issue":"5","key":"bib17","series-title":"Clin Infect Dis","first-page":"515","article-title":"Tropheryma whipplei bacteremia during fever in rural West Africa","volume":"51","author":"Fenollar","year":"2010","unstructured":"Fenollar FMediannikov OSocolovschi CTropheryma whipplei bacteremia during fever in rural West Africa. Clin Infect Dis. 2010;51(5):515-521."},{"issue":"4","key":"bib18","series-title":"AMA Arch Pathol","first-page":"464","article-title":"Whipple\u2019s disease-observation on systemic involvement. I. Cytologic observations","volume":"66","author":"Sieracki","year":"1958","unstructured":"Sieracki JC.Whipple\u2019s disease-observation on systemic involvement. I. Cytologic observations. AMA Arch Pathol. 1958;66(4):464-467."},{"key":"bib19","series-title":"J Neurol Sci","first-page":"197","article-title":"Whipple\u2019s disease","volume":"377","author":"El-Abassi","year":"2017","unstructured":"El-Abassi RSoliman MYWilliams FEngland JD.Whipple\u2019s disease. J Neurol Sci. 2017;377:197-206."},{"issue":"1-2","key":"bib20","series-title":"J Neurol Sci","first-page":"1","article-title":"Isolated inctracranial Whipple\u2019s disease\u2014report of a rare case and review of the literature","volume":"308","author":"Mohamed","year":"2011","unstructured":"Mohamed WNeil EKupsky WJJuh\u00e1sz CMittal SSanthakumar S.Isolated inctracranial Whipple\u2019s disease\u2014report of a rare case and review of the literature. J Neurol Sci. 2011;308(1-2):1-8."},{"issue":"6","key":"bib21","series-title":"Chest","first-page":"1595","article-title":"Whipple disease revealed by lung involvement: a case report and literature review","volume":"141","author":"Urbanski","year":"2012","unstructured":"Urbanski GRivereau PArtru LFenollar FRaoult DPu\u00e9chal X.Whipple disease revealed by lung involvement: a case report and literature review. Chest. 2012;141(6):1595-1598."},{"issue":"4","key":"bib22","series-title":"Am J Dermatopathol","first-page":"344","article-title":"Specific cutaneous involvement in Whipple disease","volume":"36","author":"Canal","year":"2014","unstructured":"Canal LFuente de la DRodriguez-Moreno JPenin RMMarcoval J.Specific cutaneous involvement in Whipple disease. Am J Dermatopathol. 2014;36(4):344-346."},{"issue":"1","key":"bib23","series-title":"Am J Med","first-page":"165","article-title":"Periodic acid-Schiff-negative granulomatous lymphadenopathy in patients with Whipple\u2019s disease. Localization of the Whipple bacillus to noncaseating granulomas by electron microscopy","volume":"83","author":"Wilcox","year":"1987","unstructured":"Wilcox GMTronic BSSchecter DJArron MJRighi DFWeiner NJ.Periodic acid-Schiff-negative granulomatous lymphadenopathy in patients with Whipple\u2019s disease. Localization of the Whipple bacillus to noncaseating granulomas by electron microscopy. Am J Med. 1987;83(1):165-170."},{"issue":"9936","key":"bib24","series-title":"Lancet","article-title":"Whipple\u2019s disease: an unexpected finding in a peripheral lymph node biopsy","volume":"383","author":"Walters","year":"2014","unstructured":"Walters SValliani TPrzemioslo RRooney N.Whipple\u2019s disease: an unexpected finding in a peripheral lymph node biopsy. Lancet. 2014;383(9936):2268."},{"issue":"12","key":"bib25","series-title":"J Rheumatol","first-page":"2061","article-title":"Rheumatic and musculoskeletal features of Whipple disease: a report of 29 cases","volume":"40","author":"Meunier","year":"2013","unstructured":"Meunier MPuechal XHopp\u00e9 ERheumatic and musculoskeletal features of Whipple disease: a report of 29 cases. J Rheumatol. 2013;40(12):2061-2066."},{"issue":"6","key":"bib26","series-title":"Gastroenterology","first-page":"1867","article-title":"Antibiotic treatment and relapse in Whipple\u2019s disease. Long-term follow-up of 88 patients","volume":"88","author":"Keinath","year":"1985","unstructured":"Keinath RDMerrell DEVlietstra RDobbins WO.Antibiotic treatment and relapse in Whipple\u2019s disease. Long-term follow-up of 88 patients. Gastroenterology. 1985;88(6):1867-1873."},{"issue":"11","key":"bib27","series-title":"Ann Intern Med","first-page":"875","article-title":"Treatment of refractory Whipple disease with interferon-\u03b3","volume":"129","author":"Schneider","year":"1998","unstructured":"Schneider TStallmach Avon Herbay AMarth TStrober WZeitz M.Treatment of refractory Whipple disease with interferon-\u03b3. Ann Intern Med. 1998;129(11):875-877."},{"issue":"3","key":"bib28","series-title":"J Clin Gastroenterol","first-page":"303","article-title":"Short-term antibiotic treatment in Whipple\u2019s disease","volume":"13","author":"Bai","year":"1991","unstructured":"Bai JCCrosetti EEMauri\u00f1o ECMartinez CASambuelli ABoerr LA.Short-term antibiotic treatment in Whipple\u2019s disease. J Clin Gastroenterol. 1991;13(3):303-307."},{"issue":"16","key":"bib29","series-title":"N Engl J Med","first-page":"907","article-title":"Cerebral Whipple\u2019s disease with negative jejunal histology","volume":"300","author":"Feurle","year":"1979","unstructured":"Feurle GEVolk BWaldherr R.Cerebral Whipple\u2019s disease with negative jejunal histology. N Engl J Med. 1979;300(16):907-908."},{"issue":"6","key":"bib30","series-title":"Z Rheumatol","first-page":"352","article-title":"Whipple disease with negative duodenal histology\u2014a case report and review of the literature.","volume":"53","author":"Meier","year":"1994","unstructured":"Meier JBerwanger IZangana NHellerich O.Whipple disease with negative duodenal histology\u2014a case report and review of the literature. Article in German. Z Rheumatol. 1994;53(6):352-362."},{"issue":"6","key":"bib31","series-title":"Gastroenterology","first-page":"1735","article-title":"Diagnostic application of a polymerase chain reaction assay for the Whipple\u2019s disease bacterium to intestinal biopsies","volume":"110","author":"von Herbay","year":"1996","unstructured":"von Herbay ADitton HJMaiwald M.Diagnostic application of a polymerase chain reaction assay for the Whipple\u2019s disease bacterium to intestinal biopsies. Gastroenterology. 1996;110(6):1735-1743."},{"key":"bib1","series-title":"StatPearls","article-title":"Whipple disease","author":"Antunes","year":"2023","unstructured":"Antunes CSinghal M.Whipple disease. In: StatPearls. StatPearls Publishing; 2023. Accessed December 8, 2023. http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK441937\/."},{"issue":"2","key":"bib2","series-title":"Clin Microbiol Rev","first-page":"529","article-title":"Clinical manifestations, treatment, and diagnosis of Tropheryma whipplei infections","volume":"30","author":"Dolmans","year":"2017","unstructured":"Dolmans RAVBoel CHELacle MMKusters JG.Clinical manifestations, treatment, and diagnosis of Tropheryma whipplei infections. 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Lancet Infect Dis. 2016;16(3):e13-e22."},{"issue":"1","key":"bib6","series-title":"N Engl J Med","first-page":"55","article-title":"Whipple\u2019s disease","volume":"356","author":"Fenollar","year":"2007","unstructured":"Fenollar FPu\u00e9chal XRaoult D.Whipple\u2019s disease. N Engl J Med. 2007;356(1):55-66."},{"issue":"9185","key":"bib7","series-title":"Lancet","first-page":"1178","article-title":"Tropheryma whippelii DNA in saliva of healthy people","volume":"354","author":"Street","year":"1999","unstructured":"Street SDonoghue HDNeild GH.Tropheryma whippelii DNA in saliva of healthy people. Lancet. 1999;354(9185):1178-1179."},{"issue":"12","key":"bib8","series-title":"PLOS Negl Trop Dis","first-page":"e1403","article-title":"Tropheryma whipplei: a common bacterium in rural Senegal","volume":"5","author":"Keita","year":"2011","unstructured":"Keita AKBassene HTall ATropheryma whipplei: a common bacterium in rural Senegal. PLOS Negl Trop Dis. 2011;5(12):e1403."},{"issue":"2","key":"bib9","series-title":"Int J Colorectal Dis","first-page":"114","article-title":"Decreased levels of interleukin-12p40 in the serum of patients with Whipple\u2019s disease","volume":"21","author":"Kalt","year":"2006","unstructured":"Kalt ASchneider TRing SDecreased levels of interleukin-12p40 in the serum of patients with Whipple\u2019s disease. Int J Colorectal Dis. 2006;21(2):114-120."},{"issue":"2","key":"bib10","series-title":"Gastroenterology","first-page":"442","article-title":"Defects of monocyte interleukin 12 production and humoral immunity in Whipple\u2019s disease","volume":"113","author":"Marth","year":"1997","unstructured":"Marth TNeurath MCuccherini BAStrober W.Defects of monocyte interleukin 12 production and humoral immunity in Whipple\u2019s disease. 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Lancet. 2014;383(9936):2268."},{"issue":"12","key":"bib25","series-title":"J Rheumatol","first-page":"2061","article-title":"Rheumatic and musculoskeletal features of Whipple disease: a report of 29 cases","volume":"40","author":"Meunier","year":"2013","unstructured":"Meunier MPuechal XHopp\u00e9 ERheumatic and musculoskeletal features of Whipple disease: a report of 29 cases. J Rheumatol. 2013;40(12):2061-2066."},{"issue":"6","key":"bib26","series-title":"Gastroenterology","first-page":"1867","article-title":"Antibiotic treatment and relapse in Whipple\u2019s disease. Long-term follow-up of 88 patients","volume":"88","author":"Keinath","year":"1985","unstructured":"Keinath RDMerrell DEVlietstra RDobbins WO.Antibiotic treatment and relapse in Whipple\u2019s disease. Long-term follow-up of 88 patients. 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