RESUMEN
Whipple's disease is a chronic, rare, multisystemic, infectious entity, described for the first time in 1907. Its aetiological agent is the Gram-negative rod, Tropheryma whipplei, which was isolated for the first time in 2001 from a cardiac valve of a patient with endocarditis. We present the case of a 71-year-old man, who came into the emergency room complaining of anorexia, weakness, abdominal pain and diarrhoea with haematochezia and presented disseminated palpable purpuric lesions, predominantly in the lower limbs. The upper endoscopy showed a duodenal vasculitis and the biopsy of that location revealed aspects suggestive of Whipple's disease. We started him on antibiotics according to the recent orientations with progressive clinical and analytical improvement, although he developed an immune reconstitution syndrome, which lasted for 2 weeks.
Asunto(s)
Antibacterianos/administración & dosificación , Ceftriaxona/administración & dosificación , Combinación Trimetoprim y Sulfametoxazol/administración & dosificación , Enfermedad de Whipple/diagnóstico , Enfermedad de Whipple/tratamiento farmacológico , Dolor Abdominal/etiología , Administración Intravenosa , Anciano , Artralgia/etiología , Biopsia , Diarrea/etiología , Duodeno/patología , Humanos , Masculino , Enfermedad de Whipple/sangreRESUMEN
Cholestasis has numerous causes. We present the case of a 78-year-old man with a common diagnosis in this age group and gender but with an unusual presentation. There are only 11 articles published of patients with jaundice due to a paraneoplastic syndrome associated with prostate cancer. Interleukin 6 and other proinflammatory cytokines appear to contribute to the pathophysiology of this syndrome. Our patient remains symptom free 4 months after treatment initiation.