Whipple Disease

WHIPPLE disease is multisystemic and diagnosed more frequently now because of the availability of peroral small-bowel biopsy techniques. Symptoms of arthritis and polyserositis often precede the more familiar manifestations of diarrhea, malabsorption, weight loss, abdominal pain, and skin hyperpigmentation. The primary disease may not be considered in patients first seen with arthritic symptoms and without diarrhea. Report of a Case A 76-year-old white retired farmer entered the Miami Veterans Administration Hospital complaining of intermittent foul-smelling watery stools, mild hypogastric pain, and a 25-kg (56-lb) weight loss over nine months. The patient had a 20-year history of intermittent, migratory, seronegative, non-deforming arthritis involving hips, back, knees, and wrists. For the last 15 years he had been attending the Rheumatology Clinic at the Miami Veterans Hospital. Roentgenograms of large and small joints had shown only minimal osteoporotic changes. A diagnosis of palindromic rheumatism was made. The arthritis did not respond to treatment