Whipple's disease. Analysis of 6 cases. Med Clin (Barc). 2008 Feb 23;130(6):219-2.

BACKGROUND AND 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. PATIENTS AND METHOD: 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 rheuma tism. 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.

Whipple's disease with segmental lesions in the proximal small intestine.Dtsch Med Wochenschr. 2008 Mar;133(10):460-3.

HISTORY AND ADMISSION FINDINGS: A 67-year-old man with anemia was referred to our hospital. He had suffered from rheumatoid arthritis for ten years. Two months before admission he had been an inpatient at another hospital because of heart failure. He presented with edema, slightly elevated temperature and effusion in the right knee. INVESTIGATIONS: Laboratory findings revealed a chronic inflammation and an anemia of iron malabsorption. Duodenal histology showed PAS-positive macrophages typical for Whipple's disease. Tropheryma whippelii-DNA was found by polymerase chain reaction (PCR) in synovial and cerebrospinal fluid and broncho-alveolar lavage. TREATMENT AND COURSE: Antibiotic therapy was initiated, the antirheumatic medication terminated and iron was administered intravenously. The outcome was satisfactory. CONCLUSIONS: Rare systemic diseases should be considered in patients presenting with symptoms involving several organs. Whipple's disease can be cured only by adequate antibiotic therapy. The use of PCR facilitates the correct diagnosis.