Abstract
A middle-aged white male presented with weight loss, low grade fever, and increasing abdominal girth. A small right-sided pleural effusion and moderate ascites were noted on physical examination. The pleural fluid reportedly contained an acid-fast bacillus, but it was sterile. The ascitic fluid was a sterile exudate. Following antituberculous therapy his pleural effusion and ascites resolved. Laboratory studies returned to normal. When streptomycin was discontinued, while isoniazide and p-aminosalicylic acid were continued, his previous symptoms, abnormal physical findings, and deranged laboratory studies recurred. Light and electron microscopy of peroral small bowel biopsy established the diagnosis of Whipple's disease. Peritoneoscopy, prior to starting any therapy, disclosed multiple raised nodules over the upper parietal peritoneum. Light microscopic examination of biopsies of the peritoneal nodules revealed diastase-resistant periodic acid- Schiff-positive material. After 7 months of tetracycline therapy, the nodules almost totally resolved. The presence of exudative ascites and multiple small peritoneal nodules or both should alert the clinician to the possibility of Whipple's disease.
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