Unusual Endoscopic Presentation of Whipple’s Disease

Article Outline

• Copyright

• 
  • View Large Image
  • Download to PowerPoint

For the 4-year period, a 49-year-old woman suffered from migratory transient arthralgias, weakness, weight loss, and inflammatory syndrome. In November 2001, she underwent an upper endoscopy with duodenal biopsy examination because of diarrhea that occurred 1 month previously. Endoscopy revealed an intense erythematous and erosive duodenitis (Figure A). Small-bowel biopsy specimens showed periodic acid-schiff (PAS)-positive macrophages in the lamina propria, which are an indication of Whipple’s disease (Figure B). Acquired immune deficiency syndrome infection was excluded. Trimethoprim/sulfamethoxazole was started, resulting in prompt and dramatic clinical improvement. After 6 months, a repeat endoscopy was performed that showed complete healing of the endoscopic lesions (Figure C). Biopsy specimens showed a significant decrease of the infiltration of PAS-positive macrophages.