Refractory Effusions, Crumbly Bones, Mystifying Cachexia and an Absent Mind: An Unusual Presentation of Whipple’s Disease with Review of Literature

Syed Hamza Bin Waqar¹, John Diks², Unaiza Zaman¹, Sarah Sharif¹, Taha Sheikh³, Srinivas Kolla⁴ and Isabel M. McFarlane^1,

¹Department of Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY

²Department of Pathology and Lab Sciences, State University of New York, Downstate Health Sciences University, Brooklyn, NY

³Department of Medicine, University of Toledo, OH

⁴Department of Radiology, Chief, Musculoskeletal Division, State University of New York, Downstate Health Sciences University, Brooklyn, NY

Cite this paper

Syed Hamza Bin Waqar, John Diks, Unaiza Zaman, Sarah Sharif, Taha Sheikh, Srinivas Kolla and Isabel M. McFarlane. Refractory Effusions, Crumbly Bones, Mystifying Cachexia and an Absent Mind: An Unusual Presentation of Whipple’s Disease with Review of Literature. American Journal of Medical Case Reports. 2021; 9(7):348-353. doi: 10.12691/AJMCR-9-7-2

Abstract

Whipple’s disease is a bacterial infection caused by Tropheryma whipplei and is known to cause perplexing clinical presentations, making its diagnosis challenging. The beginning by the involvement of the gastrointestinal tract, Whipple's disease can slowly progress to affect almost any organ system and lead to chronic multi-system inflammatory disease. Hereby, we present a middle age man who initially manifested with shortness of breath and chronic weight loss. He subsequently developed pleuro-pericardial effusion, ascites, mesenteric lymphadenopathy, possible myocarditis, and severe osteopenia with multiple vertebral fractures during his illness. Esophagogastroduodenoscopy with the biopsy and subsequent molecular confirmation of disease led to the confirmation of WD. Therapeutic management included two separate antibiotic regimens in an attempt to address the refractory course of WD in this patient.

Keywords

Whipple’s disease, Tropheryma whipplei, malabsorption, protein-losing enteropathy

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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