Solitary Cervical Lymphadenopathy as Only Symptom of Whipple’s Disease: A Case Report

Tropheryma whipplei is a gram-positive, non-acid-fast, and periodic acid-Schiff-positive bacillus that causes Whipple’s disease. Symptoms include chronic diarrhea, joint symptoms, and weight loss. A 53-year-old Dutch woman presented with solitary cervical lymphadenopathy, without digestive symptoms, joint pain, or weight loss. Ultrasound-guided fine-needle aspiration cytology and lymph node extirpation showed periodic acid-Schiff-positive bacteria. Polymerase chain reaction of the lymph node was positive for T. whipplei. Laboratory findings, gastroduo- denoscopy, and duodenal biopsies showed no abnormalities.
Whipple’s disease was limited to the cervical lymph node, and lymph node extirpation was deemed sufficient. Three years later, the patient presented with recurrent cervical lymphadenopathy. Polymerase chain reaction again confirmed T. whipplei. Eradication therapy with long-term antibiotics was started. This report describes the first case of Whipple’s disease limited to cervical lymphadenopathy. Whipple’s disease should be considered in case of lymphadenopathy and periodic acid-Schiff-positive bacteria, given the need for long-term antibiotic therapy.

Cite this article as: Halmans Y, Tummers-de Lind van Wijngaarden R, Clarijs R, Straetmans J. Solitary cervical lymphadenopathy as only symptom of whipple’s disease: A case report. B-ENT 2022;18(2):128-130.