The great masquerader, Whipple’s disease a rare bacterial infection – a case report

Abstract

Background: Whipple’s disease is a rare bacterial infection caused by bacterium Trophyrema Whipplei that most often affects digestive system mainly duodenum and joints. Whipple’s disease interferes with normal digestion by impairing the breakdown of foods and hampering body’s ability to absorb nutrients such as fats and carbohydrates. Histopathological characteristics overlap with other diseases (such as mycobacterial infections, enteropathy associated T-cell lymphoma, inflammatory bowel disease) which poses diagnostic challenges. We report a case 59-year-old male who presented with pyrexia of unknown origin (PUO) of 10 months duration. At the time of diagnosis, T cell lymphoma, intravascular lymphoma, enteropathy associated T cell lymphoma (EATL) and inflammatory bowel disease were under active consideration. A duodenal biopsy was sent for histopathological examination which showed enlarged villi filled by foamy macrophages which raised suspicion of WD and was further confirmed by PCR. Conclusion: This case is noteworthy because it is highly unusual and extremely rare presentation as PUO. This led to a delay in diagnosis of some 10 months, with numerous differential diagnoses investigated in the interim. Of the more common symptoms, the patient did have arthralgia (attributed to rheumatoid arthritis), but no weight loss, diarrhea or abdominal pain.