An Atypical Case of Whipple Disease With Mesenteric Lymphadenopathy and an Exudative Pleural Effusion

Whipple disease is a rare, multisystemic infection caused by the bacterium Tropheryma whipplei, primarily affecting middle-aged White men and targeting the joints, small intestine, and central nervous system. We present an atypical case of Whipple disease with mesenteric lymphadenopathy and an exudative pleural effusion. The patient was treated with intravenous ceftriaxone followed by oral trimethoprim-sulfamethoxazole. Owing to intolerance, the regimen was changed to doxycycline and hydroxychloroquine. He showed marked clinical improvement, with resolution of gastrointestinal symptoms. Whipple disease should be considered in patients with unexplained weight loss, abdominal pain, and mesenteric lymphadenopathy after malignancy and common infections have been excluded.