Whipple’s disease (WD) is a rare multi-systemic disorder caused by actinomycetes, Tropheryma Whipplei (T. Whipplei). It presents with weight loss, arthralgia and diarrhea and may involve the heart, lung or central nervous system. The use of immunosuppressive medications or underlying immunodeficiency states are associated risk factors. Six cases in transplant recipients have so far been reported worldwide. We describe our experience of Whipple’s disease in renal transplant recipients.
All renal transplant recipients who presented with diarrhea and were diagnosed with Whipple’s disease on duodenal biopsy from 2016 till 2019 were included. Their data regarding duration since transplantation, immunosuppressive therapy, symptoms, treatment response and outcome was analyzed.
Seven cases were diagnosed as Whipple’s disease based on duodenal biopsy, with histological findings of Periodic acid Schiff positive granules in macrophages. All were male. The most common symptoms were chronic diarrhea and weight loss. Average time since transplantation was 4.8 years. All patients were on azathioprine and everolimus. Clinical relapse or adverse effects was seen in 5 of 7 patients treated with doxycycline and hydroxychloroquine which was discontinued. Trimethoprim/sulphamethoxazole for one year, with initial intravenous ceftriaxone in 2 patients, resulted in complete remission in all patients at a follow-up period averaging 1.5 years.
Whipple’s diseases in renal transplant recipients most commonly presents as an intestinal disorder. Treatment of one year with Trimethoprim/sulphamethoxazole has good response with complete remission at 1.5 years of follow up. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

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