WHIPPLES-SYNDROME (UVEITIS, B27-NEGATIVE SPONDYLARTHROPATHY, MENINGITIS, AND LYMPHADENOPATHY) ASSOCIATED WITH ARTHROBACTER SP INFECTION

Objective: To report an unusual case of Whipple's disease, including u veitis, seronegative spondylarthropathy, meningitis, and lymphadenopat hy, associated with an Arthrobacter sp. infection. Design: Interventio nal case report. Patient and intervention: A 60-year-old white man pre senting with severe chronic uveitis and systemic inflammatory manifest ations was treated efficiently for Whipple's disease after histopathol ogic analysis of vitreous and inguinal adenopathy biopsy specimens. Th e authors performed a retrospective, laboratory-based evaluation of st ored tissue specimens. Measurements: Molecular analysis based on 16S r ibosomal RNA gene amplification was applied to pretreatment biopsy spe cimens of inguinal lymph node to identify a causative bacterial agent. Results: Tropheryma whippelii genome was not detected ill these speci mens. However, an amplification product was obtained after the first p olymerase chain reaction run and subsequently was sequenced. It corres ponded to an Arthrobacter sp., a gram-positive agent presenting diagno stic patterns and therapeutic management similar to those of Whipple's disease caused by T. whippelii. Conclusion: The absence of T. whippel ii identification by molecular amplification during a clinically and h istologically oriented Whipple's syndrome should not rule out the diag nosis. Arthrobacter infection may represent a new bacterial etiology o f systemic inflammatory disorders involving the eye and associated wit h periodic acid-Schiff-positive inclusions.