A 61-year-old woman received a diagnosis of undifferentiated non-erosive arthritis in 2010 and assumed methotrexate and steroids in 2014. After 1 year, she experienced watery diarrhea, vomiting, fever, weight loss, and severe hypoalbuminemia, thus being admitted into our Unit. Esophagogastroduodenoscopy showed duodenal lymphangiectasia and duodenal biopsy samples several foamy PAS-positive macrophages and villous subtotal atrophy. Transmission electron microscope demonstrated several extracellular and intracellular rod-shaped bacteria (Tropheryma whipplei). Therefore, we diagnosed Whipple's disease. Our patient assumed doxycycline/hydroxychloroquine with prompt remission of gastrointestinal symptoms. At 1 year of follow-up, she was symptom-free, histological reassessment showed almost complete mucosal healing and transmission electron microscope demonstrated bacteria breaking/disappearance. The present report demonstrates that: (i) rheumatological manifestations are common onset symptoms of Whipple's disease; (ii) immunosuppressive therapy may delay the diagnosis and worsen clinical presentation; (iii) transmission electron microscopy for specific bacteria detection/disappearance is an helpful diagnostic tool, when available.

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Introduction: pneumatosis cystoides intestinalis is an uncommon disease characterized by the presence of gas within the submucosa or subserosa of the intestine. Pneumatosis cystoides intestinalis can be often localized in colon and it may be asymptomatic.Case presentation: A 53's man, with an autistic spectrum disorder and no other comorbidities nor symptoms, underwent a colonoscopy because of finding of a wall thickening of the rectum on the last abdominal computerized tomography. The colonoscopy revealed the presence of multiple cysts, resembling a bunch of grapes at the left-colonic flexure with normal overlying mucosa. Conclusion:pneumatosis cystoides intestinalis may be asymptomatic or sometimes diagnosed incidentally during colonoscopy. The treatment approach depends on underlying cause and it can be conservative or surgical in restricted cases.