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Revista do Instituto de Medicina Tropical de São Paulo
On-line version ISSN 1678-9946
RENON, Viviane Plasse et al. Whipple's disease: rare disorder and late diagnosis . Rev. Inst. Med. trop. S. Paulo [online]. 2012, vol.54, n.5, pp.293-297. ISSN 1678-9946. http://dx.doi.org/10.1590/S0036-46652012000500010.
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.
Keywords : Whipple's disease; Tropheryma whipplei; Malabsorption syndromes.