Answer 1 Biopsy of the small intestine. This patient has Whipple’s disease, which is characterized by joint pains, diarrhea, weight loss, and lymphadenopathy. The disease typically affects men in their fourth to sixth decade. Duodenal biopsy will likely reveal the causative organism Tropheryma whippelii, a gram-positive bacillus. Treatment is trimethoprim-sulfamethoxazole (1 double-strength tablet twice daily) for 1 year. Radiographs of the hands are helpful in rheumatoid arthritis but not in Whipple’s disease. Anti-dsDNA titer would be helpful in systemic lupus erythematosus. CT scan of the abdomen would lead to nonspecific findings. Biopsy of the small intestine is more likely to reveal the organism than a lymph node biopsy. Click here to return to the questions

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