DOI: https://doi.org/10.36347/sjmcr.2026.v14i05.034

Pages: 1008-1011

Whipple’s disease is a rare systemic infection caused by Tropheryma whipplei with highly variable clinical manifestations. Articular symptoms often represent the first manifestation and may precede digestive involvement for several years, which frequently leads to misdiagnosis as chronic inflammatory rheumatic diseases such as spondyloarthritis. This misdiagnosis is problematic because immunosuppressive therapies may worsen the infection by facilitating bacterial dissemination. This article reports the case of a 56-year-old man initially diagnosed with axial and peripheral spondyloarthritis. The patient presented with bilateral uveitis, inflammatory arthralgia, chronic inflammatory back pain, and digestive symptoms. Despite treatment with methotrexate, his condition progressively worsened, with severe weight loss, persistent inflammation, and pancytopenia. Because of a previous history of inadequately treated lymph node tuberculosis and a positive QuantiFERON test, intestinal tuberculosis was suspected and anti-tuberculous therapy was initiated. However, the patient’s condition continued to deteriorate. Further investigations, including repeat endoscopy and duodenal biopsies, revealed PAS-positive macrophages consistent with Whipple’s disease. Echocardiography also identified valvular vegetations indicating endocarditis. The final diagnosis was multisystemic Whipple’s disease with articular, digestive, lymphatic, and cardiac involvement. The patient was successfully treated with intravenous ceftriaxone followed by long-term oral cotrimoxazole, leading to significant clinical improvement. This case highlights the diagnostic difficulty of Whipple’s disease due to its ability to mimic other conditions such as spondyloarthritis or intestinal tuberculosis, especially in endemic regions. Histology and PCR testing are essential diagnostic tools, while cardiac evaluation is important because T. whipplei can cause blood culture–negative endocarditis. Early diagnosis and appr