title: [Unexplained lymphadenopathy: Whipple disease].
abstract: A 58-year-old man was referred to the internal medicine outpatient department because of abdominal pain and lymphadenopathy. CT imaging revealed multiple mediastinal, para-aortic, mesenteric and pelvic lymphoma. Biopsy of an inguinal lymph node for histology purposes revealed granulomatous lymphadenitis. A watchful waiting approach was adopted. Two and a half years after first presentation, the patient presented with weight loss, fever and night sweats. CT imaging showed progressive lymphadenopathy and hepatosplenomegaly. Histopathological examination of a laparoscopically removed lymph node showed extensive infiltration with macrophages with stained rod-shaped bacteria (periodic acid-Schiff staining), which is typical of Whipple disease. PCR and biopsies of the small intestine confirmed the diagnosis. Antibiotic therapy was started with rapid clinical and biochemical improvement. A year later PCR of the duodenal biopsies was negative and the antibiotics were discontinued. Whipple disease is a rare chronic infection caused by Tropheryma whipplei. Clinical symptoms can vary, so it often takes a long time to diagnose.
authors.affiliation: Tergooiziekenhuizen, locatie Hilversum, Afd. Interne Geneeskunde, Hilversum, The Netherlands. caroline@wientjes.org
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Wientjes
authors.forename: Sylvia A
authors.initials: SA
authors.lastname: Luykx-de Bakker
authors.forename: M E F Eric
authors.initials: ME
authors.lastname: Prins
authors.forename: Sacha
authors.initials: S
authors.lastname: Lobatto
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008198:Lymph Nodes / Q000382:microbiology / Q000473:pathology; D008206:Lymphatic Diseases / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D010503:Periodic Acid-Schiff Reaction; D016896:Treatment Outcome; D015431:Weight Loss; D008061:Whipple Disease / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents