Whipple Disease

Condition

A rare malabsorptive disorder caused by the bacillus Tropheryma whipplei, affecting the heart, lungs, and CNS. Typically affects white males over 40.

History and examination

Chronic diarrhoea (steatorrhoea), arthralgias (seronegative arthropathy of peripheral joints), and weight loss. Examination may show lymphadenopathy ± fever.

Investigations

PCR for T. whipplei; jejunal biopsy showing stunted villi.

Management

IV ceftriaxone for 2 weeks, then co-trimoxazole or tetracycline for 12 months.