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Treatment of Refractory Whipple Disease with Interferon-γ

Thomas Schneider, MD, PhD; Andreas Stallmach, MD; Axel von Herbay, MD; Thomas Marth, MD; Warren Strober, MD; and Martin Zeitz, MD
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From University of the Saarland, Homburg/Saar, Germany; University of Heidelberg, Heidelberg, Germany; and the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland. Acknowledgments: The authors thank Dr. S. Kewenig for flow-cytometric analysis, Drs. M. Maiwald and H.-J. Ditton (Heidelberg) for help with polymerase chain reaction examination, and Mr. P. Rieger (Heidelberg) for help with electron microscopy. Grant Support: By grant 01 KI 9468 from the Bundesminister fur Bildung und Forschung and grant Ze 188/7-1 from the Deutsche Forschungsgemeinschaft. Requests for Reprints: Martin Zeitz, MD, Internal Medicine II, University of the Saarland, D-66421 Homburg/Saar, Germany. Current Author Addresses: Drs. Schneider, Stallmach, Marth, and Zeitz: Internal Medicine II, University of the Saarland, D-66421 Homburg/Saar, Germany Dr. von Herbay: Institute for Pathology, University of Heidelberg, Im Neuenheimer Feld 220, 69120 Heidelberg, Germany. Dr. Strober: Mucosal Immunity Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Building 10/11N238, Bethesda, MD 20892.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1998;129(11_Part_1):875-877. doi:10.7326/0003-4819-129-11_Part_1-199812010-00006
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Whipple disease is an infectious, chronic multisystem disorder characterized by diarrhea, malabsorption, arthralgias, and (in later stages) involvement of the central nervous system [1]. The infection is caused by an intracellular bacterium for which the name Tropheryma whippelii has been proposed [2]. The pathogen has only recently been successfully isolated and propagated by using interleukin-4-deactivated macrophages [3]. Before the use of antibiotics, Whipple disease was fatal [4]; even with antimicrobial therapy, some patients have severe relapse [57].

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Figure 1.
Effects of interferon-γ therapy.

Black diamonds indicate body weight; black triangles indicate serum concentration of β-carotene; white diamonds indicate CD4+ T-cell count in the peripheral blood; and white triangles indicate interferon-γ concentrations produced by peripheral blood mononuclear cells after stimulation with phytohemagglutinin isolated from the patient before, during, and after interferon-γ therapy.

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