PO133 | RECURRENT SUPERFICIAL VENOUS THROMBOSIS AS AN ATYPICAL MANIFESTATION OF WHIPPLE’S DISEASE: A CASE REPORT

C. Spillere, S. Suardi, F. Zoccatelli, L. Delfino, S. Moruzzi, F. Pizzolo, L. Marzano, E. Malloggi, F. Presa, L. Panepinto, M. Merlo, A. Moschella, S. Friso, N. Martinelli | U.O.C. Medicina Generale B, AOUI Verona, Italy. C. Spillere and S. Suardi contributed equally

Background. Whipple’s disease is a rare chronic multisystem infection caused by the Gram positive bacterium Tropheryma whipplei. It is classically characterized by both gastrointestinal and joint symptoms. Migratory arthralgias of the large joints often occur years before other symptoms appear, thus leading to frequent misdiagnosis of seronegative inflammatory arthritis. Thrombotic manifestations have generally not been recognized as clinical features of Whipple’s disease. Nonetheless, recent case reports have highlighted a potential link between Whipple’s disease and venous thrombosis.
Case Report. A 58-year-old man presented with a two-year history of seronegative oligoarthritis affecting his right wrist, which was refractory to both conventional and biologic disease-modifying antirheumatic drugs. He experienced three recurrent episodes of superficial venous thrombosis (SVT), each of them involving the great saphenous vein. There was no evidence of major or moderate risk factors for venous thromboembolism, as the patient had no family history of VTE and denied smoking. The only potential mild risk factor was an increased BMI (Body weight 95 kg, BMI 30 kg/m2). The first episode was treated with fondaparinux 2.5 mg daily for 45 days. The second episode was managed with fondaparinux followed by sulodexide, while the third was treated with fondaparinux 2.5 mg followed by rivaroxaban 10 mg daily. In light of the recurrent thrombotic events, a thrombophilia work-up was undertaken and ruled out both hereditary and acquired thrombophilic disorders. Three months later, the onset of chronic, non-bloody diarrhoea prompted diagnostic reassessment. Upper gastrointestinal endoscopy with duodenal biopsies showed mild chronic inflammation, and polymerase chain reaction testing was positive for Tropheryma whipplei, confirming Whipple’s disease. Due to the microbiological response, an antibiotic therapy was started: he was treated with ceftriaxone 2g iv for 5 days, followed by doxyciclin 100 mg bid and hydroxychloroquine 200 mg bid. After one week of antibiotic treatment, he reported a significant improvement of arthralgias. No further episodes of venous thromboembolism were reported.
Conclusions. This case directs clinical attention toward the potential association between Whipple’s disease and venous thromboembolism (VTE), aligning with recent case reports that propose venous thrombosis as an atypical manifestation of the disease. From a pathophysiological perspective, Tropheryma whipplei infection may heighten thrombotic risk through immunothrombotic mechanisms. However, further studies are warranted to explore this hypothesis and to determine whether targeted antimicrobial therapy can effectively reduce the risk of recurrent thrombotic events.