Abstract: Whipple’s disease is a rare disease that often remains undiagnosed for long periods because of difficulties on culture of the organism and the need for advanced polymerase chain reaction techniques. For these reasons, oftentimes it is initially treated as a rheumatologic disease based on presenting symptoms. There are increasing numbers of patients who require immunosuppressive medications, and little is known about the natural history of the disease in this population. This article is a follow-up to a previously published report on a patient with Whipple’s disease hip arthritis (Arthritis Rheum 1999;42:812–817). After a kidney transplantation, he went on to develop Whipple’s endocarditis 14 years after his initial diagnosis.