Constrictive pericarditis and intestinal haemorrhage due to Whipple's disease

Two months after a pericardectomy for constrictive pericarditis a 37-year-old man presented with diarrhoea, abdominal pain and weight loss. During the course of investigation he developed brisk rectal bleeding and emergency angiography revealed a bleeding site related to an area of abnormal vasculature in the caecum. At laparotomy, the small bowel was found to be inflamed and the mesenteric lymph nodes enlarged. The overall histological appearances, confirmed later on endoscopic duodenal biopsies, were those of Whipple's disease. His symptoms resolved promptly after starting tetracycline therapy. The clinical features of Whipple's disease are protean and often bizarre. We report here a case where the diagnosis was made after the onset of profuse rectal bleeding.