Persistent leucocytosis as initial manifestation of Whipples disease and development of gastric cancer in the follow up.

We report the case of a 57 year old male with Whipple's disease. The patien t was asymptomatic and an unexplained peripheral leucocytosis was found in a routine examination. It persisted as the only abnormality for one year an d then he developed articular symptoms, diarrhoea and weight loss. The diag nosis was confirmed by duodenal biopsy five years later. The leucocyte coun t ranged between 14,000 and 22,000 leuc/mm(3). Response to cotrimoxazole wa s favourable with disappearance of all signs and symptoms, including leucoc ytosis. In the last endoscopic control, eight years after initial;manifesta tions, an intramucosal gastric adenocarcinoma was diagnosed.