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Whipple disease.
Christos St Basagiannis1, George S Panagoulias, Nicholas Tentolouris
1First Department of Internal Medicine, 401 General Army Hospital, Athens, Greece.
Whipple disease, a rare bacterial infection, can present with unusual symptoms like hyperpigmentation or depression. Early diagnosis through biopsy and treatment with trimethoprim-sulfamethoxazole are crucial for successful outcomes.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Rare Diseases
Background:
- Whipple disease (WD) is a rare systemic infection caused by Tropheryma whipplei.
- Classic WD symptoms include fever, chronic diarrhea, and arthralgias, typically in middle-aged men.
- Extraintestinal manifestations are common, necessitating high clinical suspicion for atypical presentations.
Observation:
- Two patients with WD presented with rare, atypical initial symptoms.
- Patient 1 exhibited melena and generalized hyperpigmentation.
- Patient 2 presented with a two-year history of depression preceding classic WD symptoms.
Findings:
- Histologic examination of tissue biopsies confirmed Tropheryma whipplei infection in both patients.
- Atypical presentations, including hyperpigmentation and prolonged depression, were diagnosed as WD.
- Both patients responded successfully to trimethoprim-sulfamethoxazole treatment.
Implications:
- Highlights the importance of considering WD in patients with unexplained hyperpigmentation or psychiatric symptoms.
- Emphasizes the diagnostic value of histologic examination for confirming WD.
- Reinforces trimethoprim-sulfamethoxazole as an effective treatment for Whipple disease, even in atypical cases.
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