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Over the subsequent 4\u2009months, the patient\u2019s respiratory status deteriorated, leading to type 1 respiratory failure necessitating intubation. After multidisciplinary discussion, a decision was made to trial bevacizumab, an anti-VEGF agent, with subsequent improvement in respiratory status. While intubated, gastroscopy was performed; duodenal biopsies revealed pathognomonic changes of Whipple\u2019s disease, confirmed on PCR of duodenal and axillae biopsies. This was deemed the most likely unifying diagnosis; antibiotic treatment was commenced, bevacizumab was ceased, and the patient has remained well after 18 months.<\/jats:p>","DOI":"10.1136\/bcr-2023-256460","type":"journal-article","created":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T03:26:19Z","timestamp":1698204379000},"page":"e256460","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Use of bevacizumab in a patient with Whipple\u2019s disease: managing diagnostic uncertainty"],"prefix":"10.1136","volume":"16","author":[{"given":"Douglas Peter","family":"Tjandra","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Brett","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The Royal Melbourne Hospital 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