Whipple's disease diagnosed during biological treatment for joint disease

ObjectivesIncreased susceptibility to infections is among the main safety concerns raised by biological agents. We describe five cases of Whipple's disease diagnosed during treatment with biological agents.MethodsWe retrospectively identified five cases of Whipple's disease diagnosed between 2003 and 2009 in patients treated with TNFα antagonists in five French hospitals.ResultsFive patients (four male; mean age: 50.4 years; range: 38–67) underwent biological therapy according to prior diagnoses of rheumatoid arthritis (n = 2), ankylosing spondylitis (n = 2), or spondyloarthropathy (n = 1). Biological therapy failed to control the disease, which responded to appropriate antibiotics for Whipple's disease. Retrospectively, clinical symptoms before biological therapy were consistent with Whipple's disease. All five patients had favorable outcomes (mean follow-up, 29 months [13–71]).ConclusionsBiological therapy probably worsened preexisting Whipple's disease, triggering the visceral disorders. Whipple's disease must be ruled out in patients with joint disease, as patients with this spontaneously fatal condition should not receive immunosuppressive agents.