Even currently available diagnostic means may fail to reveal advanced malignant disease, and the early diagnosis of gastric cancer remains a challenge. This case is also a reminder that autopsy may disprove a supposedly definite clinical diagnosis.

The 68-year-old male patient complained of weight loss and -- since 15 years -- of arthralgias and had renal insufficiency and an aortic stenosis. Despite the lack of intestinal symptoms, M. Whipple could be diagnosed, being responsible for his symptoms and clinical signs. Under antibiotic and supportive treatment the patient recovered uneventfully.Whipple's disease, otherwise known as intestinal lipodystrophy, is a disease with various signs and symptoms. The principal signs are rheumatic complaints and weight loss. By contrast, there may be absolutely no gastrointestinal symptoms even at an advanced stage of the disease. The generally chronic clinical course of the disease may worsen acutely and may prove fatal. Symptoms frequently occur not simultaneously but successively. Diagnostically, it is crucial to consider the possibility of infection with Tropheryma whippelii primarily if the patient presents with multi-organ symptoms. The disease is easy to diagnose by taking bioptic samples endoscopically -- even in the absence of intestinal symptoms -- and antibiotic treatment is generally successful. However, permanent organic lesions must be anticipated.

Zusammenfassung Anamnese Eine bisher gesunde junge Frau wird wegen eines akuten Nierenversagens mit Hyperkalzämie stationär aufgenommen. Untersuchungen und Diagnose Ein Plasmozytom, eine infektiöse und nicht infektiöse entzündliche Genese wurden ausgeschlossen, ebenso eine Sarkoidose. Entscheidend für die Diagnose einer Hypervitaminose waren anamnestische Hinweise. Therapie und Verlauf Unter einer forcierten Diurese kommt es zu einer vollständigen Normalisierung der Hyperkalzämie und zu einer deutlichen Besserung der Nierenfunktion. Folgerung Als potenziell nephrotoxische Substanzen sind auch frei zugängliche Präparate in Erwägung zu ziehen.

The combination of autoimmune gastritis and celiac sprue is most likely a variant of the polyglandular autoimmune syndrome type 2. Early diagnosis, life-long gluten-free diet and vitamin B12 administration as well as appropriate aftercare prevent serious complications.