ABSTRACT Whipple disease is a rare multisystem infection that may be overlooked when common gastrointestinal disorders seem to explain symptoms. A 45‐year‐old woman presented with a 2‐year history of postprandial upper abdominal pain, chronic non‐bloody diarrhea, weight loss, and migratory arthralgia. Ultrasound demonstrated gallstones and periportal lymphadenopathy. Upper endoscopy revealed distal gastric ulcers and pale yellow‐white shaggy mucosa in the duodenum; duodenal biopsies showed PAS‐positive, acid‐fast–negative foamy macrophages. Open cholecystectomy was performed for symptomatic cholelithiasis, and excisional biopsy of periportal lymph nodes revealed concordant PAS‐positive histiocytic infiltration. Tissue PCR for Tropheryma whipplei was positive in both the duodenum and lymph nodes. The patient received ceftriaxone induction followed by trimethoprim–sulfamethoxazole for 12 months and bismuth quadruple therapy for Helicobacter pylori . Symptoms resolved and inflammatory markers normalized by 3 months; repeat duodenal biopsy and tissue PCR at 1 year were negative, with no relapse at 2 years.
Oljira et al. (Mon,) studied this question.