title: Whipple's disease: rare disorder and late diagnosis.
abstract: Whipple's disease is a rare systemic infectious disorder caused by the bacterium Tropheryma whipplei. We report the case of a 61-year-old male patient who presented to emergency room complaining of asthenia, arthralgia, anorexia, articular complaints intermittent diarrhea, and a 10-kg weight loss in one year. Laboratory tests showed the following results: Hb = 7.5 g/dL, albumin = 2.5 mg/dL, weight = 50.3 kg (BMI 17.4 kg/m²). Upper gastrointestinal endoscopy revealed areas of focal enanthema in the duodenum. An endoscopic biopsy was suggestive of Whipple's disease. Diagnosis was confirmed based on a positive serum polymerase chain reaction. Treatment was initiated with intravenous ceftriaxone followed by oral trimethoprim-sulfamethoxazole. After one year of treatment, the patient was asymptomatic, with Hb = 13.5 g/dL, serum albumin = 5.3 mg/dL, and weight = 70 kg (BMI 24.2 kg/m²). Whipple's disease should be considered a differential diagnosis in patients with prolonged constitutional and/or gastrointestinal symptoms. Appropriate antibiotic treatment improves the quality of life of patients.
authors.affiliation: Department of Gastroenterology, Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brazil.
authors.forename: Viviane Plasse
authors.initials: VP
authors.lastname: Renon
authors.forename: Marcelo Campos
authors.initials: MC
authors.lastname: Appel-da-Silva
authors.forename: Rafael Bergesch
authors.initials: RB
authors.lastname: D'Incao
authors.forename: Rodrigo Mayer
authors.initials: RM
authors.lastname: Lul
authors.forename: Luciana Schmidt
authors.initials: LS
authors.lastname: Kirschnick
authors.forename: Bruno
authors.initials: B
authors.lastname: Galperim
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D057210:Delayed Diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D035583:Rare Diseases / Q000175:diagnosis* / Q000188:drug therapy; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D008061:Whipple Disease / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D015662:Trimethoprim, Sulfamethoxazole Drug Combination