A CASE OF WHIPPLES-DISEASE WITH UVEITIS, SEPSIS AND ENDOCARDITIS

Whipple's disease is a systemic disease which may virtually affect any organ system, but in many cases it involves the small intestine causi ng gastrointestinal symptoms. The differential diagnosis is difficult since symptoms may be nonspecific. We report the case of a 44-year old white male patient with a history of migrating arthralgia and chronic fatigue. The patient newly developed an uveitis and underwent a vitre ctomy; the further clinical work-up including gastroscopy with intesti nal biopsy revealed no sufficient diagnosis. Subsequently, the patient 's condition deteriorated with marked weight loss, fever and progressi ve weakness. An anaerobic sepsis with a corynebacterium was confirmed and with i.v.-antibiotics the patients's condition improved markedly. The further examinations disclosed enlarged mesenteric lymph nodes and the involvement of other organs (endocard, liver). CT-guided biopsy o nly showed fatty degeneration, but operative adenectomy confirmed Whip ple's disease. The patient remained without relapse on long-term antib iotic treatment with doxycyclin until today. Obviously, in our case th e intestinal biopsies failed to detect Whipple's disease after the suc cessful initiation of antibiotic treatment. In the absence of gastroin testinal findings and with concomitant secondary diseases the definiti ve diagnosis can be difficult. In addition, the previous uveitis and t he endocardial involvement are most interesting.