Whipple's Disease with Multiple Serous Effusions as the Clinical Manifestation: A Case Report and Literature Review
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Background Whipple’s disease, caused by Tropheryma whipplei , is a rare multisystem infectious disorder with diverse clinical manifestations. Typical symptoms include arthralgia, nausea, vomiting, diarrhea, and weight loss, while nonspecific features such as fever, anemia, and lymphadenopathy may also occur. Presentations with multiple serous effusions are exceedingly rare. Diagnosis remains particularly challenging in resource-limited regions due to nonspecific symptoms and limited access to advanced diagnostic techniques. Case Presentation: A 34-year-old male presented with fever, vomiting, diarrhea, mild dry cough, and anorexia. Whole-body computed tomography revealed systemic inflammatory changes mimicking vasculitis, including multiple serous effusions (pleural, peritoneal, pericardial, and pelvic) and omental thickening. Initial empirical anti-infective therapy failed. Serological tests, pleural fluid analysis, and thoracoscopic pleural biopsy excluded systemic vasculitis and pleural malignancy. Histopathological consultation raised suspicion of Whipple’s disease. Despite targeted antibiotic therapy for Tropheryma whipplei , clinical improvement was suboptimal. Given diagnostic uncertainty, 18F-fluorodeoxyglucose positron emission tomography demonstrated diffuse peritoneal thickening with hypermetabolism, prompting biopsy. Definitive diagnosis was achieved via laparoscopic omental biopsy, confirmed by histopathology, Periodic acid-Schiff staining, and polymerase chain reaction. Combination therapy with doxycycline, hydroxychloroquine, and short-term glucocorticoids induced sustained remission. Follow-up over two years of targeted anti- Tropheryma whipplei therapy demonstrated favorable recovery. Conclusions Multiple serous effusions are an uncommon clinical manifestation of Whipple’s disease. Early identification of Tropheryma whipplei infection and timely targeted therapy are critical for improving patient prognosis.
