Hoskote Sumedh S, Georgescu Anca, Ganjhu Lisa, Zeizafoun Nebras, Polsky Bruce
1Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY; 2Department of Medicine, Division of Infectious Diseases, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY; 3Department of Medicine, Division of Gastroenterology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY; and 4Department of Pathology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY.
Am J Ther. 2014 Sep-Oct;21(5):e143-7. doi: 10.1097/MJT.0b013e3182691cdc.
Whipple disease is a disorder caused by Tropheryma whipplei, a ubiquitous Gram-positive bacillus. In addition to gastrointestinal manifestations, many other systems may be involved in Whipple disease. Pulmonary hypertension (PH) is a rare manifestation of Whipple disease, and its clinical course is not well established. We report a case of a 45-year-old woman who presented with typical gastrointestinal manifestations of Whipple disease, which was diagnosed by duodenal biopsy. She was also noted to have elevated pulmonary arterial pressures on transthoracic echocardiography. There was no evidence of left-sided valvular disease, hypertrophy, or dyskinesis, and there was no evidence of endocarditis. The patient was started on intravenous ceftriaxone for 6 weeks and then transitioned to oral trimethoprim-sulfamethoxazole for a year. The patient demonstrated clinical improvement, endoscopic and histologic improvement, and also resolution of PH. This is the third reported case of PH that is convincingly secondary to Whipple disease that resolved after appropriate antibiotic therapy.
惠普尔病是一种由普遍存在的革兰氏阳性杆菌——惠普尔嗜组织菌引起的疾病。除胃肠道表现外，惠普尔病还可能累及许多其他系统。肺动脉高压（PH）是惠普尔病的一种罕见表现，其临床病程尚不明确。我们报告一例45岁女性，她表现出惠普尔病典型的胃肠道症状，经十二指肠活检确诊。经胸超声心动图检查还发现她的肺动脉压升高。没有左侧瓣膜疾病、肥厚或运动障碍的证据，也没有心内膜炎的证据。患者开始静脉注射头孢曲松6周，然后转为口服甲氧苄啶-磺胺甲恶唑治疗一年。患者的临床症状、内镜及组织学表现均有改善，肺动脉高压也得到缓解。这是第三例有充分证据表明继发于惠普尔病的肺动脉高压经适当抗生素治疗后得以缓解的报告病例。
