Whipple's disease diagnosed in a patient with suspected sarcoidosis.

Abstract We present a case of a 51-year-old patient with chronic diarrhea, weight loss, polyarthralgia and diffuse lymphadenopathy. Laboratory work-up showed anemia, leuco- and thrombocytosis, and increased C-reactive protein (CRP). Due to an inconspicuous differential leucocyte count and lymph node biopsy findings showing granulomatous lymphadenopathy, we initially suspected sarcoidosis. Colonoscopy found no abnormalities and duodenal biopsies showed negative Periodic acid-Schiff stains. However, PCR testing on these biopsies revealed tropheryma whipplei DNA. Further PCR testing of urine and cerebrospinal fluid revealed T. whipplei DNA as well. The patient was treated with ceftriaxone for 2 weeks followed by trimethoprim for a year. A rapid improvement of his symptoms was seen.