Whipple's disease with melaena and multiple petechial haemorrhages in duodenal mucosa

A case of Whipple''s disease with bloody diarrhoea as the main symptom at the moment of diagnosis is reported. Radiolabelled erythrocyte scanning, mesenteric angiography, small bowel x-rays and total colonoscopy failed to localize the intestinal bleeding site. Upper gastrointestinal endoscopy revealed a severe involvement of the postbublar mucosa with multiple petechial haemorrhages and haemorrhagic suffusions of 1-2 mm in diameter. No abnormalities were present in laboratory tests of haemostatis. Duodenal biopsies showed histologic evidence of Whipple''s disease. After 7 days of antibiotic therapy bloody diarrhoea disappeared. On the 14th day of therapy duodenoscopy showed normal duodenal mucosa while duodenal biopsies revealed no improvement of histologic lesions. This case indicates that the main clinical feature of untreated Whipple''s disease can be melaena due to severe longstanding involvement of postbulbar mucosa. Macroscopic lesions rapidly heal after antibiotic treatment despite the persistence of the histologic pattern of the disease.