A juvenile, misdiagnosed case of Whipple's disease.

Dear Editor, :KLSSOH¶GLVHDVH :' LVDUDUHV\ ndrome which generally occurs in patients aged more than 50 years, especially in farmers, carpenters, and gardeners (1). WD may present with different and not specific symptoms, so that diagnosis is frequently a challenge for physicians. An appropriate, lo ng -term antibiotic therapy is effective, and untreated disease is lethal (2). Therefore, a prompt diagnosis is mandatory. A 37 -year -old male baker, with a compensated hypothyroidism, complained of migrant polyarthralgies in 2005, and a diagnosis of sero negative joint disease was performed. Patient received a therapy with ibuprofen (400 mg b.i.d) for 6 months, and a steroid therapy (prednisone 16 mg/day) was added due to persistence of symptoms. A methotrexate (100 mg/die) therapy was started after 6 mont hs, tapering steroid therapy. Five months later, patient complained of severe diarrhoea (10 -15 bowel movements/day), vomiting, anorexia, low -grade fever, and progressive, severe weight loss (22 kg), and he was admitted to our Unit on May 2007. At entry, si deropenic anaemia (haemoglobin 10 g/dl; ferritin 17 ng/dl), increased ESR to 25 mm/h, and increased leucocytes count with 15,2 x 10