title: Deep Vein Thrombosis as Initial Manifestation of Whipple Disease.
abstract: BACKGROUND
  Wipple disease (WD) is a rare chronic disease caused by the bacillusTropheryma whipplei. Constitutive, rheumatologic, gastrointestinal, cardiac, cerebral, lymphatic, cutaneous, and ophthalmological signs are possible systemic symptoms. However, thrombotic manifestations are rarely described as "stroke-like syndrome" or arterial thrombosis. Diagnosis is based on clinical manifestations and pathological examination. Laboratory findings may include anemia, leukocytosis, and thrombocytosis.
  
  
  OBJECTIVE
  We report a case of venous thrombosis as initial manifestation of WD.
  
  
  METHODS
  We describe the case of a 53-year-old male with iliofemoral vein thrombosis followed by intermittent diarrhea, loss of appetite, abdominal distension, and bloating. A mild malnutrition state with a weight loss of 13 kg, pallor (+/4 +), presence of lower-limb edema (+/4 +), and hypertympanic distended abdomen occurred. Laboratory tests on admission revealed anemia, positive inflammatory activity tests, and normal coagulation. Endoscopic examination showed villous edema with white dotted infiltrates in the second duodenal portion and intestinal lymphangiectasia in the terminal ileum. Pathological examination revealed numerous macrophages with positive periodic acid-Schiff inclusions. Venous Doppler ultrasound showed extensive deep thrombosis on the left lower limb and recanalization of the femoral vein in the right lower limb. The patient was treated with ceftriaxone and enoxaparin sodium, which led to an improvement of gastrointestinal and thrombosis symptoms.
  
  
  CONCLUSIONS
  Hypercoagulability, endothelial damage, vasculitis, and blood stasis are present inT. whippleiinfection, which are associated with the activation of inflammatory mechanisms as well as procoagulant and thromboembolic events. WD should be part of the differential diagnosis of diseases that cause venous thrombosis of unknown origin.
authors.affiliation: Universidade Federal da Paraíba, João Pessoa, Brazil.
authors.forename: Mônica Souza de Miranda
authors.initials: MS
authors.lastname: Henriques
authors.affiliation: Universidade Federal da Paraíba, João Pessoa, Brazil.
authors.forename: Alexandre Rolim
authors.initials: AR
authors.lastname: da Paz
authors.affiliation: Universidade Federal da Paraíba, João Pessoa, Brazil.
authors.forename: Ana Beatriz Person
authors.initials: AB
authors.lastname: Gaertner
authors.affiliation: Universidade Federal da Paraíba, João Pessoa, Brazil.
authors.forename: Cibelle Ingrid Stephen
authors.initials: CI
authors.lastname: Melo
authors.affiliation: Universidade Federal da Paraíba, João Pessoa, Brazil.
authors.forename: Priscyanne Lins
authors.initials: PL
authors.lastname: Filgueiras
authors.affiliation: Universidade Federal da Paraíba, João Pessoa, Brazil.
authors.forename: Rafaella Alencar
authors.initials: RA
authors.lastname: Jerome
keywords: Thromboembolic events; Tropheryma whipplei; Vasculitis; Venous thrombosis; Whipple disease