[Weight loss, joint pain and abdominal lymphadenopathy as signs of sarcoidosis, but also of Whipple's disease].
Two patients, a woman aged 66 and a man aged 56 years, with an inflammatory syndrome, weight loss, joint pain and abdominal lymphadenopathy received long-term treatment with corticosteroids for alleged sarcoidosis. No long-term remission was induced and the patients were referred for a second opinion. Eventually the diagnosis of Whipple's disease was established 5 years after the appearance of the first symptoms in the case of the female patient and 4 years after in the case of the male patient. Both patients showed a marked clinical improvement after treatment with trimethoprim-sulfamethoxazole. An atypical presentation of alleged sarcoidosis should suggest the possibility of Whipple's disease, especially in the case of gastrointestinal symptoms and the failure to respond to corticosteroids, and warrants duodenal biopsy. The presence of granulomas with an elevated angiotensin-converting enzyme level is not pathognomonic for sarcoidosis. It is vitally important to distinguish the two disorders, as Whipple's disease is an infectious disorder that requires antibiotic therapy to prevent a fatal outcome.
Deeren
D
D
Afd. Interne Geneeskunde, Universitaire Ziekenhuizen Leuven, België. driesdeeren@hotmail.com
Vanderschueren
S
S
Ectors
N
N
Blockmans
D
D
Bobbaers
H
H
D000005:Abdomen; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D018771:Arthralgia / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008206:Lymphatic Diseases / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012507:Sarcoidosis / Q000175:diagnosis / Q000188:drug therapy; D017211:Treatment Failure; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D015431:Weight Loss; D008061:Whipple Disease / Q000175:diagnosis* / Q000188:drug therapy
D000305:Adrenal Cortex Hormones; D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
Gewichtsverlies, pijnlijke gewrichten en vergrote klieren in de buik als uitingen van sarcoïdose, maar ook van de ziekte van Whipple.