The Immune Reconstitution Inflammatory Syndrome in Whipple Disease A Cohort Study

Background: Whipple disease, which is caused by infection with Tropheryma whipplei, can be treated effectively with antimicrobi-als. Occasionally, inflammation reappears after initial improvement; this is often interpreted as refractory or recurrent disease. However, polymerase chain reaction for T. whipplei in tissue is sometimes negative during reinflammation, indicating absence of vital bacteria, and this reinflammation does not respond to antimicrobials but does respond to steroids. Objective: To demonstrate that the immune reconstitution inflam-matory syndrome (IRIS) occurs in patients treated for Whipple disease