WHIPPLES-DISEASE - 2 NEW CASES REPORTED

Two cases of Whipple's disease in adults seen in a general hospital wa rd over a ten-year period are reported, Both patients were young and p resented with chronic diarrhea, The diagnosis was made based on pathol ogic studies of specimens collected during exploratory laparotomy. Bot h patients had frequent recurrences due to poor compliance with the an timicrobial therapy, and both developed mycobacterial infections (lepr osy and pulmonary tuberculosis, respectively) testifying to the disord ers of cellular immunity characteristic of Whipple's disease, In one o f the patients each recurrence was accompanied with a bout of highly i nflammatory polyarthritis. The other patient developed ankylosing spon dylitis that remained active despite stabilization of the Whipple's di sease. Whipple's disease contributed only 1.29% of the cases of chroni c diarrhea seen during the study period, A review of the literature de monstrated that Whipple's disease is a multisystem disorder often resp onsible for misleading presentations, and that delayed recurrences are common and sometimes cause severe neurologic and cardiac manifestatio ns. Tropheryma whippelii has recently been identified as the likely ca use of Whipple's disease.