Whipple's disease presenting as pleuropericarditis

A diagnosis of Whipple's disease was made by peroral jejunal biopsy in a 48 year old woman with pleuropericarditis of unknown etiology who had been followed for 4 years prior to the onset of clinical and laboratory signs of malabsorption. Pretreatment immunologic investigations revealed lymphopenia, decreased immunoglobulin G (IgG) with normal immunoglobulin A (IgA) and M (IgM) serum levels, and marked impairment of delayed hypersensitivity. Following successful treatment, the total lymphocyte count and serum IgG level returned to normal, and there was no demonstrable impairment in delayed hypersensitivity. This latter observation is in contrast with recent reports of immunologic investigations in patients with Whipple's disease which demonstrate that most patients continue to manifest significant deficits in delayed hypersensitivity despite successful therapy.