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Whipple's disease: when diarrhea is absent.
Sagrario María Santos Seoane1, Rocío Martínez Gutiérrez2, Victoria Ines Venta Menéndez3
1Medicina Interna, Hospital de Cabueñes, España.
Revista Espanola De Enfermedades Digestivas
|May 30, 2019
Summary
Whipple's disease, a rare bacterial infection, often presents with joint pain before digestive issues, delaying diagnosis. This case highlights the importance of considering Tropheryma whipplei in unexplained joint symptoms.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Rheumatology
Background:
- Whipple's disease is a rare, chronic, multisystemic infection caused by Tropheryma whipplei.
- Clinical manifestations are diverse, frequently leading to delayed diagnosis, with an average delay of 6 years.
- Cardinal symptoms include arthralgias, weight loss, diarrhea, and abdominal pain, but joint issues can precede GI symptoms.
Discussion:
- Joint manifestations can precede classic gastrointestinal symptoms by years, complicating early diagnosis.
- The absence of typical digestive symptoms in this case initially masked the possibility of Whipple's disease.
- Diagnostic laparoscopy was crucial in identifying the condition when it was not initially suspected.
Key Insights:
- Tropheryma whipplei infection can present insidiously with predominantly joint symptoms.
- Delayed diagnosis is common due to the varied and often non-specific initial presentation.
- A high index of suspicion is necessary for diagnosing Whipple's disease, especially in cases with atypical symptomology.
Outlook:
- Further research into earlier diagnostic markers for Whipple's disease is warranted.
- Improved awareness among clinicians regarding the diverse presentations of Whipple's disease may expedite diagnosis.
- Exploring the pathogenetic mechanisms linking Tropheryma whipplei to joint inflammation could offer new therapeutic targets.