Supplementary Material for: Fever and increased gastrointestinal uptake on positron emission tomography after anti-tumour necrosis factor therapy: A case report of Whipple’s disease

Introduction: Whipple’s disease is a rare condition that can present with atypical and non-specific features requiring a high index of suspicion for diagnosis.
Case Presentation: We present a case of a man in his 40s with peripheral arthritis and bilateral sacro-ileitis for 4-5 years that was treated with an anti-tumour necrosis factor (TNF) therapy, which led to worsening of his symptoms, elevation of the inflammatory markers, and the development of fever, night sweats, anorexia, and a significant weight loss. The patient had no abdominal pain, diarrhea, or other gastrointestinal symptoms. An FDG-PET scan showed increased uptake in the stomach and cecum. Endoscopic examination showed inflammatory changes in the stomach and normal mucosa of the duodenum, jejunum, terminal ileum, cecum, and colon. Histopathology was inconclusive, but the diagnosis was confirmed with Tropheryma whipplei PCR testing. He had no neurological symptoms, but cerebrospinal fluid Tropheryma whipplei PCR was positive. He was treated with intravenous ceftriaxone 2g daily for four weeks, followed by trimethoprim/sulfamethoxazole 160/800mg twice daily for one year with close monitoring and follow-up.
Conclusion: This case presents an atypical and challenging presentation of Whipple’s disease and the importance of proactive testing for neurological involvement.

引言：惠普尔病（Whipple’s disease）是一种罕见病症，其临床表现可呈现非典型且非特异性的特征，临床诊断需保持高度怀疑。
病例报告：本文报告1例40余岁男性患者，其外周关节炎与双侧骶髂炎病程达4~5年，曾接受抗肿瘤坏死因子（TNF）治疗，却出现症状加重、炎症标志物升高，同时伴随发热、盗汗、食欲减退及显著体重下降。患者无腹痛、腹泻或其他胃肠道症状。氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）显示胃与盲肠摄取显像剂增高。内镜检查可见胃黏膜存在炎症改变，十二指肠、空肠、回肠末端、盲肠及结肠黏膜未见异常。组织病理学检查结果无明确诊断意义，但通过惠普尔养障体（Tropheryma whipplei）聚合酶链式反应（PCR）检测最终确诊。患者无神经系统症状，但脑脊液惠普尔养障体PCR检测结果呈阳性。患者接受静脉滴注头孢曲松2g、每日1次，疗程4周，后续予以甲氧苄啶/磺胺甲噁唑（160/800mg）、每日2次，疗程1年，并辅以密切监测与随访。
结论：本病例展现了一例非典型且诊疗难度较高的惠普尔病，凸显了对神经系统受累情况进行主动筛查的重要性。