Whipple disease.
Whipple disease (WD) is a rare disease caused by Tropheryma whipplei. The classic profile of the patient is that of a middle-aged man presenting with fever, chronic diarrhea, and arthralgias. Extragastrointestinal manifestations are not rare. A high degree of clinical suspicion for the disease is needed in atypical cases. Trimethoprim-sulfamethoxazole is the treatment of choice. We present two patients with WD. The first presented with melena and generalized hyperpigmentation. The second had depression for two years before the typical symptoms. Both hyperpigmentation and long-lasting depression without the typical manifestations of the disease are rare. Histologic examination of tissue biopsies was diagnostic for WD. Both patients were treated successfully with trimethoprim-sulfamethoxazole.
First Department of Internal Medicine, 401 General Army Hospital, Athens, Greece.
Christos St
CS
Basagiannis
George S
GS
Panagoulias
Nicholas
N
Tentolouris
Stavros
S
Basoukeas
Dimitrios
D
Sambaziotis
Spiros D
SD
Ladas
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D018771:Arthralgia / Q000209:etiology; D001706:Biopsy; D003863:Depression / Q000209:etiology; D003967:Diarrhea / Q000382:microbiology; D004384:Duodenoscopy; D005334:Fever / Q000209:etiology; D006801:Humans; D017495:Hyperpigmentation / Q000209:etiology; D008297:Male; D008551:Melena / Q000209:etiology; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D008061:Whipple Disease / Q000175:diagnosis* / Q000188:drug therapy* / Q000523:psychology
D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination