An unusual cause of diarrhoea and arthritis

A 41-year-old lady was investigated by several hospital teams over a 5-year period. She initially presented with arthralgia but over time developed a myriad of signs and symptoms. Later, she was admitted for investigation of profound weight loss, anaemia and a rising C-reactive protein. Extensive gastrointestinal investigations were performed. Duodenal biopsy revealed microscopic evidence of villous blunting with prominent collections of macrophages within the lamina propria and submucosa. These changes were consistent with Whipple's disease and confirmed by polymerase chain reaction on the biopsy sample. Initiation of antibiotic therapy led to normalisation of inflammatory markers and marked clinical improvement. Even in younger female patients, this disease should always be considered.