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Misdiagnosing Whipple's disease in the young
  1. Danai Papakonstantinou1,
  2. Michael J Riste1,
  3. Gerald Langman2,
  4. Ed Moran1
  1. 1Department of Infectious Diseases and Tropical Medicine, Birmingham Heartlands Hospital, Heart of England NHS Hospital Trust, Birmingham, UK
  2. 2Histopathology Department, Heart of England NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Danai Papakonstantinou, danaipapakonstantinou{at}


Whipple's disease is considered an infection of middle-aged white men of European ancestry. Cases are rare and disproportionately associated with occupational exposure to soil or animals. We report the case of a man aged 22 years with no risk factors, erroneously diagnosed with, and treated for, toxoplasmosis on the basis of consistent lymph node histology. The correct diagnosis was delayed by the dramatic symptomatic improvement resulting from this therapy. Whipple's disease should be considered in cases of granulomatous lymphadenopathy of unknown cause, even if the age of the patient does not fit the classic presentation of the disease.

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  • Contributors EM, DP and MR provided clinical care for the patient. GL performed the histological examination and provided the relevant histological pictures for the paper. DP and MR wrote the manuscript and contributed equally to this report. EM supervised the case throughout and corrected the manuscript. GL also corrected the article. All authors have seen and approved the manuscript and have contributed significantly to the work.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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