{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:09:39Z","timestamp":1785434979217,"version":"3.56.0"},"reference-count":9,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100015763","name":"University of Szeged","doi-asserted-by":"publisher","award":["IV-114-1\/2026.SZAOK"],"award-info":[{"award-number":["IV-114-1\/2026.SZAOK"]}],"id":[{"id":"10.13039\/501100015763","id-type":"DOI","asserted-by":"publisher"}]},{"award":["IV-114-1\/2026.SZAOK"],"award-info":[{"award-number":["IV-114-1\/2026.SZAOK"]}],"id":[{"id":"https:\/\/ror.org\/01pnej532","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003825","name":"Hungarian Academy of Sciences","doi-asserted-by":"publisher","award":["BO\/00340\/25"],"award-info":[{"award-number":["BO\/00340\/25"]}],"id":[{"id":"10.13039\/501100003825","id-type":"DOI","asserted-by":"publisher"}]},{"award":["BO\/00340\/25"],"award-info":[{"award-number":["BO\/00340\/25"]}],"id":[{"id":"https:\/\/ror.org\/02ks8qq67","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012550","name":"National Research, Development and Innovation Fund","doi-asserted-by":"crossref","award":["EK\u00d6P-345 SZTE"],"award-info":[{"award-number":["EK\u00d6P-345 SZTE"]}],"id":[{"id":"10.13039\/501100012550","id-type":"DOI","asserted-by":"crossref"}]},{"award":["EK\u00d6P-345 SZTE"],"award-info":[{"award-number":["EK\u00d6P-345 SZTE"]}],"id":[{"id":"https:\/\/ror.org\/03g2am276","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Whipple disease is a rare systemic infection caused by Tropheryma whipplei that often presents with nonspecific gastrointestinal symptoms and may mimic other disorders. We report the case of a 75-year-old woman with type 2 diabetes mellitus who presented with chronic diarrhoea and a 15 kg unintentional weight loss over 6 months despite preserved appetite. Laboratory investigations revealed iron-deficiency anaemia, hypoproteinaemia, mild inflammatory and liver function abnormalities, and peripheral eosinophilia. Extensive infectious, autoimmune, and gastrointestinal investigations were unrevealing. Abdominal computed tomography demonstrated mesenteric lymphadenopathy, raising suspicion for lymphoma. Histopathological examination of duodenal biopsies revealed numerous foamy macrophages containing periodic acid\u2013Schiff-positive, diastase-resistant granular material, consistent with Whipple disease. Ziehl\u2013Neelsen staining additionally demonstrated acid-fast bacilli, and subsequent investigations confirmed concomitant Mycobacterium szulgai infection. The significance of this finding remains uncertain, as it may represent either true coinfection or incidental colonisation. A potential explanation is that T. whipplei-induced macrophage dysfunction creates a permissive intracellular niche for nontuberculous mycobacteria, although supporting evidence is lacking. Following antimicrobial therapy, the patient experienced marked clinical improvement with resolution of symptoms and an 8 kg weight gain. This case highlights the diagnostic challenges of Whipple disease and the need to consider concomitant mycobacterial infection when acid-fast organisms are identified.<\/jats:p>","DOI":"10.3390\/diagnostics16152315","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T15:05:42Z","timestamp":1784819142000},"page":"2315","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Whipple Disease with Concurrent Mycobacterium szulgai Infection: A Rare Diagnostic and Therapeutic Challenge"],"prefix":"10.3390","volume":"16","author":[{"given":"N\u00e1ndor","family":"Giba","sequence":"first","affiliation":[{"name":"Department of Pathology, County Hospital Fej\u00e9r, Szent Gy\u00f6rgy Hospital, 8000 Sz\u00e9kesfeh\u00e9rv\u00e1r, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kinga Orsolya","family":"Dunkel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, County Hospital Fej\u00e9r, Szent Gy\u00f6rgy Hospital, 8000 Sz\u00e9kesfeh\u00e9rv\u00e1r, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eszter","family":"Boros","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, County Hospital Fej\u00e9r, Szent Gy\u00f6rgy Hospital, 8000 Sz\u00e9kesfeh\u00e9rv\u00e1r, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judit","family":"Csomor","sequence":"additional","affiliation":[{"name":"Department of Pathology and Experimental Cancer Research, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6792-6789","authenticated-orcid":false,"given":"D\u00f3ra","family":"Par\u00f3czai","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, University of Szeged, 6720 Szeged, Hungary"},{"name":"Department of Pulmonology, University of Szeged, 6772 Deszk, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5081-7313","authenticated-orcid":false,"given":"Tam\u00e1s","family":"Lantos","sequence":"additional","affiliation":[{"name":"Department of Medical Physics and Informatics, University of Szeged, 6720 Szeged, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9434-2989","authenticated-orcid":false,"given":"Anita","family":"Sejben","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Szeged, 6725 Szeged, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/ciaa241","article-title":"Treatment of nontuberculous Mycobacterial pulmonary disease: An official ATS\/ERS\/ESCMID\/IDSA clinical practice guideline","volume":"71","author":"Daley","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1007\/s10238-026-02064-z","article-title":"Deciphering whipple\u2019s disease complexity","volume":"26","author":"Korybski","year":"2026","journal-title":"Clin. Exp. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"105","DOI":"10.18683\/germs.2021.1246","article-title":"First case of Whipple\u2019s disease successfully treated with tigecycline","volume":"11","author":"Foteinogiannopoulou","year":"2021","journal-title":"Germs"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s40249-026-01441-w","article-title":"Whipple\u2019s disease with multiple serous effusions as the clinical manifestation: A case report and literature review","volume":"15","author":"Zhang","year":"2026","journal-title":"Infect. Dis. Poverty"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e280","DOI":"10.1016\/S1473-3099(22)00128-1","article-title":"Whipple\u2019s disease and Tropheryma whipplei infections: From bench to bedside","volume":"22","author":"Boumaza","year":"2022","journal-title":"Lancet Infect. Dis."},{"key":"ref_6","first-page":"e51388","article-title":"Mycobacterium szulgai pulmonary infection in an immunocompromised patient","volume":"15","author":"Neves","year":"2023","journal-title":"Cureus"},{"key":"ref_7","first-page":"e108067","article-title":"Diagnostic challenges in disseminated Mycobacterium szulgai infection: A case report in the setting of advanced HIV infection","volume":"18","author":"Salti","year":"2026","journal-title":"Cureus"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"77","DOI":"10.4103\/jgid.jgid_152_24","article-title":"Clinical presentations and species spectrum of nontuberculous Mycobacteria in suspected pulmonary tuberculosis cases","volume":"17","author":"Das","year":"2025","journal-title":"J. Glob. Infect. 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