Whipple's disease--a challenging diagnosis.

Ana C Carneiro, Palmira Lima, Isabel P Barbosa, F Carneiro Chaves


Whipple's Disease is a rare multisystemic disease caused by Gram-positive bacillus, Tropheryma whippelii, family of Actinobacterias and group of Actinomycetes. Because the disease is rare and has different forms of presentation the diagnosis comes frequently late. The authors present the case of a white man, 50 years old, admitted with a clinical picture characterized by weight loss, abdominal pain, ascites, diarrhea. He suffered of arthralgias for four years. The diagnosis was made by biopsy of mesenteric adenopathies and liver, during the laparotomy. The biopsy specimens showed numerous aggregates of foamy macrophages containing granular periodic acid-shiff (PAS)--positive material, diastase resistant. Afterwards, the bacillus was identified by electronic microscopy. The patient was treated with trimethoprim-sulfamethoxazole. Symptoms disappeared and biological values returned to normal. The authors present the case and discuss auxiliary exams, differential diagnosis, follow-up, treatment and review the main characteristics of the disease.

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