Whipple’s disease is a rare, chronic, insidious multisystemic bacterial infection caused by Tropheryma whipplei, a gram-positive bacillus. It predominantly affects middle-aged White men with a history of occupational exposure to soil or animals, suggesting genetic predisposition and altered immune response. Its classic clinical presentation includes migratory arthralgias, chronic diarrhea, crampy abdominal pain, and progressive weight loss due to intestinal malabsorption. However, pulmonary and neurological symptoms, lymphadenopathy, and fever may also occur. The disease should be suspected in patients with unexplained multisystemic manifestations, and its diagnosis is based on small-bowel biopsy with periodic acid-Schiff (PAS) staining and PCR confirmation, potentially involving analysis of other tissues. Treatment requires bactericidal antibiotics with good central nervous system penetration for a prolonged period, as well as regular clinical and laboratory monitoring. We report the case of O.R.P., a 50-year-old man who had a 7-year history of progressive asthenia, lower limb edema, and recurrent ascites. He reported significant weight loss (20 kg in 10 months), chronic diarrhea, dyspnea with minimal exertion, and peripheral lymphadenopathy. His condition was highly debilitating, limiting basic and occupational activities. Laboratory tests showed microcytic, hypochromic anemia, lymphopenia, and left shift. Further evaluation with colonoscopy revealed distal ileal thickening, and gastric and duodenal mucosal biopsies showed an infiltrate with foamy macrophages that stained PAS-positive. Based on these findings, the diagnosis of Whipple’s disease was established, and treatment with oral doxycycline plus oral hydroxychloroquine was started. After three months, there was resolution of anasarca, cessation of diarrhea episodes, and marked weight gain (19 kg). Therapy was continued, with recommendations for multidisciplinary outpatient follow-up, including infectious diseases and nutrition. This case highlights the relevance of considering Whipple’s disease in the differential diagnosis of malabsorption syndromes and chronic unexplained systemic conditions, particularly in middle-aged men with joint and gastrointestinal manifestations. As recommended, multidisciplinary follow-up is essential, since relapses may occur years after initial treatment.
Jacques et al. (Sun,) studied this question.