A 29-year-old male with no history of disease who consulted in 2001 for liquid diarrhea (7-10 daily stools), diffuse abdominal pain, colic type and weight loss (18 kg since the onset of symptoms) of 5 months.
In recent weeks, the patient complained of recurrent self-limiting arthralgias.
He comes to the gastroenterology specialist, in an outpatient way, who requests elemental analytics, coprocultivatives, seizures and opaque enema that are normal.
Subsequently, a normal colon was revealed.
In the ileum, hyperemic, edematous and friable mucosa was observed, with a whitish plug, granular and isolated, which becomes confluent in the form of "grain of rice" as the patient progresses.
While waiting for the result of the biopsies, it worsens its clinical situation with an increase in the number of stools and hyperthermia of 39o so it is admitted to the hospital.
The general condition, fever of 38.5° and diffuse abdominal pain were observed.
There are no skin lesions or adenopathies.
The following data are highlighted in the analysis: hematocrit 29.8% (40-50), platelets 409.000 mm3 (140 000-dl), total proteins 4.9 g/dl, albumin 2 g/dl transfer test (60%), iron 10 ng/50
The determinations of bilirubin, glucose, urea, creatinine, vitamin B12, folic acid, thyroid hormones, triglycerides, phosphorus, magnesium, liver tests, immunoglobulins, transferrin, ferritin and antiendomysial antibodies are normal and antigli.
Microbiological study of feces, blood and urine, as well as serology for viruses and bacteria (human immunodeficiency virus, hepatitis B and C virus, Salmonella, Clostridium difficile and mycobacteria), were normal or negative.
Intestinal transit, ultrasound and CT scan showed no evidence of pelvic malignancy.
Fibrogastroscopy detected a marked thickening of the folds in the second and third duodenal portions with edema and granular appearance with white deposits.
The pathology of the duodenal mucosa confirmed the presence of PAS positive granules, diastase resistant, findings also present in the previous ileal biopsy.
16S ribosomal RNA sequence of T. whippleii was positive in the duodenum.
The patient was treated with penicillin (1.2 x 106 units per day) plus streptomycin (1 g/day) for 14 days, followed by cotrimoxazole (800/160 mg every 12 hours) for one year.
The evolution was favorable, disappearing the fever and gaining weight in the first two weeks.
At 10 months, duodenoscopy was normal but isolated foci of PAS positive macrophages persisted in the lamina propria.
PCR in the duodenal mucosa was negative.
After 8 years of evolution, duodenal and ileal biopsies did not show histological findings of the optical coherence tomography disease.
