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Whipple's Disease: A Case Report
Marta Batista1, Maria Luis Santos1, Cristina Silva1
1Internal Medicine, Hospital da Senhora da Oliveira, Guimarães, PRT.
Abstract:
Whipple's disease (WD) is caused by Tropheryma whipplei, frequently found in lamina propria's macrophages in the small intestine. It is a rare and chronic systemic infection, and the principal clinical manifestations are diarrhea, weight loss, abdominal pain, and arthralgia. The diagnosis is difficult mainly because of its rarity and should be considered in patients with arthralgias, diarrhea, abdominal pain, and weight loss after more common conditions have been excluded. The laboratory diagnosis is established by a duodenal biopsy. The treatment involves 14 days of intravenous antibiotics with good penetration in the cerebrospinal fluid (i.e., ceftriaxone) and one-year treatment with oral co-trimoxazole. Early diagnosis and proper treatment are crucial because it improves the prognosis. We report the case of a 58-year-old female with skin hyperpigmentation, loss of appetite and weight (16% of body weight in three months), nausea, upper abdominal pain, and diarrhea. Esophagogastroduodenoscopy and colonoscopy were performed to obtain biopsy samples, which, together with laboratory tests and microbiological studies, led to a diagnosis of Whipple's disease.
Insights
Whipple's disease (WD), a rare bacterial infection, presents with gastrointestinal and joint symptoms. Early diagnosis via biopsy and prompt antibiotic treatment are vital for improved patient outcomes.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Microbiology
Background:
- Whipple's disease (WD) is a rare, chronic systemic infection caused by *Tropheryma whipplei*.
- It primarily affects the small intestine's macrophages, leading to malabsorption and systemic symptoms.
- Clinical manifestations include diarrhea, weight loss, abdominal pain, and arthralgia, complicating diagnosis.
Observation:
- A 58-year-old female presented with significant weight loss, hyperpigmentation, nausea, abdominal pain, and diarrhea.
- Diagnostic workup involved esophagogastroduodenoscopy and colonoscopy with biopsy.
- Laboratory and microbiological studies confirmed *Tropheryma whipplei* infection.
Findings:
- Biopsy analysis revealed *Tropheryma whipplei* in the lamina propria's macrophages.
- The patient's symptoms were consistent with advanced Whipple's disease.
- Diagnosis was established through integrated clinical, laboratory, and microbiological findings.
Implications:
- Early diagnosis of Whipple's disease is crucial for effective management and prognosis.
- Prompt treatment with intravenous and oral antibiotics is essential.
- This case highlights the importance of considering WD in patients with unexplained gastrointestinal and systemic symptoms.
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