Trust Your Gut: Recognizing Whipple's Disease Beyond the Intestine

Whipple's disease is a rare, chronic, multisystemic infection caused by Tropheryma whipplei (T. whipplei), classically presenting with gastrointestinal manifestations but frequently involving extraintestinal organs that may delay diagnosis. We report two cases illustrating the clinical spectrum of Whipple's disease: a 59-year-old man with malabsorption, chronic diarrhea, and weight loss, and a 44-year-old man with inflammatory polyarthralgia and constrictive pericarditis who developed gastrointestinal symptoms eight years later. In both cases, diagnosis was established by duodenal biopsy demonstrating periodic acid-Schiff (PAS)-positive macrophages and polymerase chain reaction confirmation of T. whipplei. Both patients were treated with intravenous ceftriaxone followed by long-term trimethoprim-sulfamethoxazole, with favorable clinical outcomes. These cases highlight the diagnostic challenges posed by atypical Whipple's disease and underscore the importance of considering this diagnosis in patients with unexplained multisystem inflammatory syndromes.