A subcutaneous nodule with whipple's disease: key to early diagnosis?

Abstract

Arthritis usually precedes the other manifestations of Whipple's disease (WD).During this "lead time," which may extend as long as 35 years (l), the correct diagnosis may be virtually impossible without recourse to synovial biopsy.There are scattered accounts of subcutaneous nodules with Whipple's disease, but only a single published report of a nodule biopsy-a brief notation that "the changes were consistent with rheumatoid arthritis" (2).This is a report of a patient with a nodule that followed the onset of oligoarthritis by 3 years and preceded the appearance of diarrhea and weight loss by 12 years.Biopsy of the nodule utilizing electron microscopy disclosed specific diagnostic features of Whipple's disease.