A 28-year-old female blogger presents with unexplained bleeding from her gums (coagulopathy), progressing to kidney failure, mitral valve damage requiring heart surgery consideration, liver failure with day-night reversal, and malabsorption. The diagnosis of Whipple disease is ultimately reached after the team discovers changes in her stool consistency coinciding with her adoption of a vegetarian diet, indicating malabsorption as the underlying cause of her multisystem failure.
Also known as: Heart valve disease
The patient's mitral valve is severely damaged (nearly gone) as a complication of her underlying infection, requiring valve replacement surgery. The team discusses pig valve versus plastic valve options, and the patient ultimately chooses the pig valve after her underlying infection is successfully treated.
Also known as: Liver failure
The patient develops liver failure as part of her multisystem disease process, manifesting as day-night reversal (discovered through analysis of her blog posting times). This is initially mistaken as a symptom of lymphoma but is actually due to the underlying Whipple disease. The team estimates she has only 3-4 days without treatment.
Also known as: Kidney failure
The patient develops kidney failure with dark (mud-colored) urine as part of the systemic manifestations of her underlying infection. This leads the team to consider various diagnoses including hemolytic uremic syndrome before arriving at the correct diagnosis.