Whipple's disease: rare disorder and late diagnosis

Rev Inst Med Trop Sao Paulo. 2012 Sep-Oct;54(5):293-7. doi: 10.1590/s0036-46652012000500010.

Abstract

Whipple's disease is a rare systemic infectious disorder caused by the bacterium Tropheryma whipplei. We report the case of a 61-year-old male patient who presented to emergency room complaining of asthenia, arthralgia, anorexia, articular complaints intermittent diarrhea, and a 10-kg weight loss in one year. Laboratory tests showed the following results: Hb = 7.5 g/dL, albumin = 2.5 mg/dL, weight = 50.3 kg (BMI 17.4 kg/m²). Upper gastrointestinal endoscopy revealed areas of focal enanthema in the duodenum. An endoscopic biopsy was suggestive of Whipple's disease. Diagnosis was confirmed based on a positive serum polymerase chain reaction. Treatment was initiated with intravenous ceftriaxone followed by oral trimethoprim-sulfamethoxazole. After one year of treatment, the patient was asymptomatic, with Hb = 13.5 g/dL, serum albumin = 5.3 mg/dL, and weight = 70 kg (BMI 24.2 kg/m²). Whipple's disease should be considered a differential diagnosis in patients with prolonged constitutional and/or gastrointestinal symptoms. Appropriate antibiotic treatment improves the quality of life of patients.

Publication types

  • Case Reports

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Ceftriaxone / therapeutic use
  • Delayed Diagnosis
  • Humans
  • Male
  • Middle Aged
  • Rare Diseases / diagnosis*
  • Rare Diseases / drug therapy
  • Treatment Outcome
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use
  • Whipple Disease / diagnosis*
  • Whipple Disease / drug therapy

Substances

  • Anti-Bacterial Agents
  • Ceftriaxone
  • Trimethoprim, Sulfamethoxazole Drug Combination