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A rare presentation of hypovolemic shock secondary to Whipple’s disease

Tandon, Parula; Huang, Viviana; Jaffer, Nasirb; Kirsch, Richardc; Croitoru, Kennetha

European Journal of Gastroenterology & Hepatology: May 2019 - Volume 31 - Issue 5 - p 642–645
doi: 10.1097/MEG.0000000000001363
Case Report

Whipple’s disease is a rare, multisystem infection caused by the Gram-positive Tropheryma whippelii organism. In addition to neurological and rheumatological manifestations, this disease can result in significant gastrointestinal symptoms such as malabsorption, diarrhea, and weight loss. Given the diagnostic challenge and rare occurrence, a high index of suspicion is critical to prevent morbidity and mortality from this otherwise highly infectious disease transmitted via the fecal-oral route. We present a very rare but near-fatal case of hypovolemic shock secondary to protein-losing enteropathy and gastrointestinal bleeding from small bowel T. whippelii infection. Furthermore, the epidemiology, clinical presentation, diagnosis, and management of Whipple’s disease is reviewed.

aDepartment of Medicine, Division of Gastroenterology, Mount Sinai Hospital, University of Toronto

bDepartment of Medical Imaging

cDepartment of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada

Correspondence to Kenneth Croitoru, MDCM, FRCPC, Division of Gastroenterology, Mount Sinai Hospital, Room 437 600 University Avenue, Toronto, ON, Canada M5G 1×5 Tel: +1 416 586 4800 x7454; fax: +1 416 586 4747; e-mail:

Received December 21, 2018

Accepted January 10, 2019

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