Whipple's disease: imaging contribution for a challenging case

Abstract

Whipple's disease is a rare and difficult-to-diagnose infectious disease, related to infection by gram-positive bacillum Tropheryma whipplei Clinical manifestations are very variable, but the classic form usually begins with recurring arthritis, followed several years later by non-specific abdominal symptoms, leading to late diagnosis. We present the case of a 52-year-old man who was admitted in the emergency department with an insidious clinical picture characterised by weight loss, abdominal pain, diarrhoea and arthralgias. An abdominal ultrasound was performed, showing findings suggestive of Whipple's disease, which, in conjunction with the clinical and laboratory findings, allowed the diagnosis to be correctly addressed. Upper endoscopy with duodenal biopsy revealed findings compatible with Whipple's disease, and the diagnosis was also confirmed through PCR techniques of blood. The patient was given antibiotic therapy, with rapid and substantial clinical improvement.

Keywords: gastroenterology; malabsorption; radiology.

Figure 1

US images show hyperechoic jejunal fold thickening, multiple mesenteric and retroperitoneal hyperechoic adenopathy and peritoneal effusion. US, ultrasound.

Figure 2

CT scan shows enlarged mesenteric and retroperitoneal adenopathy, prominent jejunal folds and massive low-density peritoneal effusion.