Whipple Disease: A Two-Decade Multisystem Masquerade Preceding Gastrointestinal Presentation

Whipple disease is a rare multisystem infection caused by Tropheryma whipplei that can present with extraintestinal manifestations preceding gastrointestinal symptoms by years. We report an unusually prolonged course in a patient with nearly 2 decades of treatment-refractory seronegative inflammatory polyarthritis who later developed gastrointestinal symptoms. Although initial upper endoscopy with biopsies was nondiagnostic, repeat evaluation following symptom progression demonstrated small bowel involvement, with diagnosis established by periodic acid-Schiff staining and polymerase chain reaction of small bowel biopsies. This case highlights the diagnostic challenge of Whipple disease and the importance of maintaining clinical suspicion in longstanding refractory symptoms and multisystem involvement.