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Cutaneous lesions in Whipple disease (WD) are infrequent, and the histological findings are usually nonspecific. Specific cutaneous lesions have rarely been described and usually involve the subcutaneous fat. We report a patient diagnosed with WD, who developed multiple small subcutaneous nodules after antibiotic treatment was administered. In addition to septal panniculitis, the cutaneous biopsy showed a mild granulomatous dermal reaction with PAS-positive macrophages characteristic of WD. A positive polymerase chain reaction in the cutaneous sample confirmed the presence of Tropheryma whipplei in the skin. Dermatopathologists should be aware that not only subcutaneous lesions but also dermal lesions may exhibit specific findings of WD.

Although there is relevant information on frequency of osteoporosis in women with rheumatoid arthritis (RA), data about male patients are limited. We evaluated the frequency of osteoporosis in a group of Spanish men with RA followed in a university hospital.From the database of our bone densitometry unit, we searched for men with RA evaluated between January 1991 and December 2004 and identified 187 patients, 156 of whom were older than 50 years. Previously recorded demographic, disease, and treatment-related variables were collected. Bone mineral density (BMD) was measured by dual x-ray absorptiometry (DEXA). Osteoporosis was defined according to the criteria of the World Health Organization (WHO), recommended for postmenopausal Caucasian women, as a T scoreor= -2.5 SD, and the International Society for Clinical Densitometry (ISCD), which indicates the same diagnostic threshold, but only in men over age 50 years.BMD was lower than in the general population in both lumbar spine [Z score -0.41 +/- 1.00 (95% CI -0.55 to -0.26)] and femoral neck [Z score -0.46 +/- 0.95 (95% CI -0.60 to -0.31)]. When the WHO threshold for postmenopausal women was applied, frequency of osteoporosis was 13% at lumbar spine, 12% at the femoral neck, and 21% in at least one of the evaluated sites. When ISCD criteria were applied, the frequency of osteoporosis was 13%, 14%, and 23%, respectively.Frequency of osteoporosis in men is considerably lower than that traditionally established in women with RA, independent of the diagnostic criteria applied.