title: [Whipple's disease. Analysis of 6 cases].
abstract: OBJECTIVE
  Whipple's disease (WD) is an infrequent multisystemic process, with a bacterial etiology and with a marked variability in relation to its clinical manifestations. The diagnosis is established by histopathologic study or by polymerase chain reaction (PCR) test. Our objective was to analyze the clinical characteristics and evolution of these patients.
  
  
  METHODS
  We have reviewed the patients diagnosed with WD in our hospital during the last 20 years (1987-2007).
  
  
  RESULTS
  We describe 6 patients with WD (5 men and one woman), with a mean age of 47 years. Most patients presented articular symptoms (n = 5), in 3 cases with intermittent rheumatism. The mean period of time previous to diagnosis was 59 months. All patients developed a chronic diarrheic syndrome, constitutional syndrome and polyadenopathies at the time of diagnosis. Laboratory studies showed increased erythrocyte sedimentation rate and C-reactive protein values, ferropenic microcytic anemia and low serum levels of cholesterol. The clinical diagnosis was confirmed by pathologic study in 5 patients, and by means of PCR study of spleen tissue in one patient. All patients were treated with cotrimoxazole for 2 years, with resolution of the symptoms. After a mean follow-up of 98 months, no recurrence of the symptoms has been observed in any case.
  
  
  CONCLUSIONS
  Articular symptoms in the form of intermittent rheumatism are the most common form of presentation of WD. Diarrheic and constitutional syndrome, which are observed later in all patients, as well as the presence of adenopathies, oblige us to discard this process.
authors.affiliation: Servicio de Reumatología, Hospital Clínic, Universidad de Barcelona, Barcelona, España.
authors.forename: Raquel
authors.initials: R
authors.lastname: Reyes
authors.forename: Pilar
authors.initials: P
authors.lastname: Peris
authors.forename: Faust
authors.initials: F
authors.lastname: Feu
authors.forename: Angels
authors.initials: A
authors.lastname: Martínez-Ferrer
authors.forename: Angels
authors.initials: A
authors.lastname: Quera
authors.forename: Nuria
authors.initials: N
authors.lastname: Guañabens
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D008061:Whipple Disease / Q000175:diagnosis*