Systemic Tropheryma whippleii Infection Associated with Monoclonal B-Cell Proliferation: A Helicobacter pylori-Type Pathogenesis?

Sa Wang, Linda M. Ernst, Brian R. Smith, Giovanni Tallini, John G. Howe, Jill Crouch, Dennis L. Cooper*

*Corresponding author for this work

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

We report a case of Whipple disease in a 55-year-old woman who presented with arthralgia, weight loss, and lymphadenopathy. Tropheryma whippleii bacilli were identified in the mesenteric lymph nodes by diastase-resistant periodic acid-Schiff stain and confirmed by electron microscopy. Retrospectively, previous biopsy specimens from the duodenum and right axillary lymph node of this patient, which were initially considered to demonstrate reactive changes, also showed features consistent with involvement by Whipple disease. At the time of presentation, a large K-restricted monoclonal B-cell population with the phenotype CD20+CD19+CD5-CD10-was identified in the patient's peripheral blood, lymph nodes, and bone marrow by flow cytometry study. The monoclonality of the mesenteric lymph node β cells was confirmed by immunohistochemical stain for κ chain after antigen retrieval and also by polymerase chain reaction with the primer set targeting FR2-VH. Routine cytogenetic study failed to reveal any chromosomal abnormalities, and polymerase chain reaction for Bcl-2 major and minor breakpoint cluster of t(14: 18) was not detected. The monoclonal B-cells have persisted in blood for the entire follow-up period (10 months). The possibility of reactive monoclonal B-cell proliferation versus Whipple disease-related B-cell lymphoma is discussed.

Original languageEnglish (US)
Pages (from-to)1619-1622
Number of pages4
JournalArchives of Pathology and Laboratory Medicine
Volume127
Issue number12
StatePublished - Dec 1 2003

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Medical Laboratory Technology

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    Wang, S., Ernst, L. M., Smith, B. R., Tallini, G., Howe, J. G., Crouch, J., & Cooper, D. L. (2003). Systemic Tropheryma whippleii Infection Associated with Monoclonal B-Cell Proliferation: A Helicobacter pylori-Type Pathogenesis? Archives of Pathology and Laboratory Medicine, 127(12), 1619-1622.