[Whipple disease associated with pulmonary arterial hypertension. Jarisch-Herxheimer reaction after antibiotic therapy]

Presse Med. 2001 Oct 27;30(31 Pt 1):1549-51.
[Article in French]

Abstract

Background: Pulmonary hypertension is an uncommon feature of Whipple's disease and the underlying pathophysiological mechanism remains a subject of debate.

Case report: A 57-year-old woman was hospitalized for exploration of migrating joint pain that had developed for 5 years. Histologically proven Whipple's disease was diagnosed on duodenal biopsies. The lung angiogram performed to explore signs of right heart failure demonstrated pulmonary hypertension and ruled out pulmonary embolism. Abundant pericardial effusion developed progressively. Antibiotic therapy using sulfamethoxazole-trimethoprime led to a systemic Jarisch Herxheilmer reaction. The pulmonary hypertension resolved rapidly, the pericardial effusion more slowly.

Discussion: The pulmonary hypertension in this patient appeared to be directly related to Whipple's disease, probably via vascular infiltration by Tropheryma whippeli.

Publication types

  • Case Reports
  • English Abstract

MeSH terms

  • Anti-Infective Agents / adverse effects
  • Female
  • Humans
  • Hypertension, Pulmonary / complications*
  • Middle Aged
  • Trimethoprim, Sulfamethoxazole Drug Combination / adverse effects
  • Whipple Disease / complications*
  • Whipple Disease / drug therapy

Substances

  • Anti-Infective Agents
  • Trimethoprim, Sulfamethoxazole Drug Combination