A 54-year-old male with a two-year history of seronegative symmetric polyarthritis with sprouts of involvement in the shoulders, elbows, knees, ankles and metatarsals.
He was treated with varying doses of corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs) and methotrexate in the Rheumatology Department.
The patient was admitted for severe epigastric pain, high fever up to 39o, weight loss of 6 kg and general malaise in the last two months.
Physical examination revealed a 37.6o febricula, non-painful cervical wheeling adenopathies, and painful upper hemiabdomen at fixation.
The laboratory analysis showed leukocytosis of 17.3 x103/mcl, and total proteins of 5.4 g/dl with albumin of 2.66 g/dl. Faecal fat was gastrointestinal bleeding.
A CT scan showed numerous lymph nodes, some larger than 2 cm. A laparoscopic mesenteric lymph node biopsy showed PAS positive macrophages.
An oral endoscopy with duodenal biopsy confirmed the diagnosis.
It was initially treated with ceftriaxone and streptomycin for 15 days and later with TM-SF.
After 6 months of treatment, the patient had clear improvement, and arthralgias persisted without arthritis.
She is currently under treatment.
