A 75-year-old woman presented with a 1-year history of liquid stools without pathological products, weight loss of 13 kg, asthenia and arthralgia with arthritis of the right wrist and knees.
She was diagnosed with pyrophosphate arthropathy and arthrosis.
He also had nonspecific dizziness and gait instability.
Physical examination revealed severe malnutrition, edema of the lower limbs, limitation of upper face, discrete ventral gait with trunk flexion.
Laboratory tests showed microcytic anemia and albumin of 3.0 g/dl without other abnormalities.
Faecal fat 11.2 g/day
The gastrointestinal transit showed dilated small bowel loops with image suggesting malarsorption.
Oral endoscopy showed plaques in the second duodenal portion which were compatible with Whipple's disease on biopsy.
She was treated with penicillin G and streptomycin two weeks later with TM-SF. After one year of treatment she had gained 8 kg, had diarrhea and had significantly improved instability.
In the duodenal biopsy after treatment, the positive PAS zones were already amorphous and the electronic endoscopy showed degenerated membranes without viable bacilli.
Treatment was discontinued.
